Individual provider Active NPI

Georgina Chen, PA-C

  • Physician Assistant
  • Colton, CA
National Provider Identifier
1386119998
Registry record updated Oct 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA58347 Issued in CA
Practice address
400 N Pepper Ave
Colton, CA 92324-1801
Phone
(909) 580-3390
NPI assigned
Oct 10, 2018
Last updated
Oct 21, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA58347 CA Primary

Addresses

Primary practice location

400 N Pepper Ave
Colton, CA 92324-1801

Mailing address

400 N Pepper Ave
Colton, CA 92324-1801
Phone (909) 580-3390

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210106002229 CA Practitioner - Physician Assistant 3173936424 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1901 W Lugonia Ave
Redlands, CA 92374-9703
Phone (909) 557-1600

400 N Pepper Ave
Arrowhead
Colton, CA 92324-1801
Phone (909) 580-3390

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
58347CAMDGeneral Practice Dentistry
PA58347CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
San Bernardino Medical Orthopaedic Group, Inc. CurrentSince Nov 9, 2020 Accepting new patients
San Bernardino Medical Orthopaedic Group, Inc. CurrentSince Nov 9, 2020 Accepting new patients
Ahmc Whittier Hospital Medical Center LP Past Accepting new patients

Locations

400 N Pepper Ave
Colton, CA 92324
Phone (909) 580-1400

1798 N Garey Ave
Pomona, CA 91767
Phone (909) 865-9810

1801 Orange Tree Ln
Ste 200
Redlands, CA 92374
Phone (909) 557-1607

1901 W Lugonia Ave
Ste 310
Redlands, CA 92374
Phone (909) 793-2964

4500 Brockton Ave
Ste 306
Riverside, CA 92501
Phone (951) 275-9000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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

Hospital & facility affiliations 1

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": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1386119998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-3390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-580-3390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHEN",
        "first_name": "GEORGINA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-10-10",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colton, CA

Sources for this page

Verify at the official NPI Registry.