NPIMap

Organization Active NPI

Chaparral Medical Group Inc

  • Endocrinology, Diabetes & Metabolism Physician
  • Claremont, CA
National Provider Identifier
1376506956
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
CHAPARRAL MEDICAL GROUP INC
Practice address
138 Harvard Ave
Chaparral Medical Group
Claremont, CA 91711-4716
Phone
(909) 624-4503
Fax
(909) 624-6364
NPI assigned
Apr 6, 2006
Reactivated
Apr 18, 2022
Last updated
Apr 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2022

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

Authorized official

Name
Mrs. Adrienne M Walker
Title
Contracts Administrator
Phone
(909) 398-1550

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU Primary
Surgery Physician 208600000X NU

Addresses

Primary practice location

138 Harvard Ave
Chaparral Medical Group
Claremont, CA 91711-4716

Mailing address

840 Towne Center Dr
Administrative Resources
Pomona, CA 91767-5900
Phone (909) 398-1550

Other identifiers 1

IdentifierTypeStateIssuer
GR0052951MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031110000605 CA Part B Supplier - Clinic/Group Practice 6800709403 Receives reassigned benefits from 139 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Claremont, CA; Pomona, CA

Other NPIs on the same Medicare enrollment 12

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1376506956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 TOWNE CENTER DR",
            "address_2": "ADMINISTRATIVE RESOURCES",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675900",
            "telephone_number": "909-398-1550",
            "fax_number": "909-398-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "138 HARVARD AVE",
            "address_2": "CHAPARRAL MEDICAL GROUP",
            "city": "CLAREMONT",
            "state": "CA",
            "postal_code": "917114716",
            "telephone_number": "909-624-4503",
            "fax_number": "909-624-6364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAPARRAL MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-06",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "deactivation_date": "2022-03-11",
        "reactivation_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ADRIENNE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CONTRACTS ADMINISTRATOR",
        "authorized_official_telephone_number": "909-398-1550",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0052951",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Claremont, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.