NPIMap

Organization Active NPI

Southern California Primary Care Medical Group, Inc

  • Family Medicine Physician
  • Lake Elsinore, CA
National Provider Identifier
1376632281
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC
Practice address
31581 Canyon Estates Dr
Lake Elsinore, CA 92532-0424
Phone
(951) 244-3500
Fax
(951) 244-3535
NPI assigned
Oct 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Dr. Mohammad R Danesh, M.D.NPI 1811999261
Title
Director
Phone
(951) 244-3500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

31581 Canyon Estates Dr
Lake Elsinore, CA 92532-0424

Mailing address

31581 Canyon Estates Dr
Lake Elsinore, CA 92532-0424
Phone (951) 244-3500

Other names 1

  • Canyon Lake Urgent & Family Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050713000250 CA Part B Supplier - Clinic/Group Practice 5698701472 Receives reassigned benefits from 6 practitioners
Practice locations: Lake Elsinore, CA

National Provider Directory

National Provider Directory

Locations

31740 Railroad Canyon Rd
Ste 3
Canyon Lake, CA 92587
Phone (951) 244-3500

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1376632281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31581 CANYON ESTATES DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320424",
            "telephone_number": "951-244-3500",
            "fax_number": "951-244-3535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31581 CANYON ESTATES DR",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320424",
            "telephone_number": "951-244-3500",
            "fax_number": "951-244-3535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2025-09-02",
        "certification_date": "2025-05-14",
        "status": "A",
        "authorized_official_last_name": "DANESH",
        "authorized_official_first_name": "MOHAMMAD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "951-244-3500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Lake Urgent & Family Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Elsinore, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2025; 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.