NPIMap

Organization Active NPI

Elite Medical Group of Southern California

  • Internal Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1386424679
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
ELITE MEDICAL GROUP OF SOUTHERN CALIFORNIA
Practice address
8816 Foothill Blvd # 103-338
Rancho Cucamonga, CA 91730-7199
Phone
(000) 000-0000
NPI assigned
Oct 3, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

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

Authorized official

Name
Baker Hillawy, MDNPI 1427408749
Title
Owner
Phone
(774) 444-1004

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
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

8816 Foothill Blvd # 103-338
Rancho Cucamonga, CA 91730-7199

Mailing address

8816 Foothill Blvd # 103-338
Rancho Cucamonga, CA 91730-7199

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240408000388 CA Part B Supplier - Clinic/Group Practice 3779921952 Receives reassigned benefits from 14 practitioners
Practice locations: Riverside, CA; San Bernardino, CA

National Provider Directory

National Provider Directory

Locations

8816 Foothill Blvd
#103338
Rch Cucamonga, CA 91730

Practitioners & affiliated clinicians

Practitioners 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1696291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1386424679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8816 FOOTHILL BLVD # 103-338",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8816 FOOTHILL BLVD # 103-338",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307199",
            "telephone_number": "000-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE MEDICAL GROUP OF SOUTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-03",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "HILLAWY",
        "authorized_official_first_name": "BAKER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "774-444-1004",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; 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.