Individual provider Active NPI

Johnny A Liquete, MD

  • Internal Medicine Physician
  • Moreno Valley, CA
National Provider Identifier
1366438574
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A49014 Issued in CA
Practice address
14114 Business Center Dr
Suite D
Moreno Valley, CA 92553-9113
Phone
(951) 697-1150
Fax
(951) 697-1189
NPI assigned
Sep 22, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A49014 CA Primary

Addresses

Primary practice location

14114 Business Center Dr
Suite D
Moreno Valley, CA 92553-9113

Mailing address

PO Box 8838
Moreno Valley, CA 92552-8838
Phone (951) 697-1150

Other identifiers 1

IdentifierTypeStateIssuer
00A490141MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100617000743 CA Practitioner - Infectious DiseasePractitioner - Internal Medicine 8628147469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Infectious DiseaseAlso: Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12980 Frederick St
Suite D
Moreno Valley, CA 92553-5263
Phone (951) 697-1150

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
John Liquete MD Inc CurrentSince Oct 1, 2012 Accepting new patients
Dignity Health Past Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
San Gorgonio Memorial Hospital Past Accepting new patients
Uhs Corona Inc Past Accepting new patients

Locations

14114 Business Center Dr
Ste D
Moreno Valley, CA 92553
Phone (951) 419-0003

12980 Frederick St
Ste D
Moreno Valley, CA 92553
Phone (951) 243-2600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310947200000",
    "number": "1366438574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8838",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925528838",
            "telephone_number": "951-697-1150",
            "fax_number": "951-697-1189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14114 BUSINESS CENTER DR",
            "address_2": "SUITE D",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925539113",
            "telephone_number": "951-697-1150",
            "fax_number": "951-697-1189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIQUETE",
        "first_name": "JOHNNY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-22",
        "last_updated": "2011-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A49014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A490141",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.