Organization Active NPI

Orange Psychiatric Medical Group, Inc

  • Psychiatry Physician
  • Murrieta, CA
National Provider Identifier
1386999829
Registry record updated Jul 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
ORANGE PSYCHIATRIC MEDICAL GROUP, INC
Practice address
41670 Ivy St
Suite C
Murrieta, CA 92562-9433
Phone
(951) 696-5220
Fax
(951) 696-5222
NPI assigned
Jul 20, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2012

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

Authorized official

Name
Dr. Sai B Chundu, M.D.
Title
President/ Owner
Phone
(951) 737-1917

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X CA
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X CA
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X CA
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X CA
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X CA Primary

Addresses

Primary practice location

41670 Ivy St
Suite C
Murrieta, CA 92562-9433

Mailing address

770 Magnolia Ave
Suite 1F
Corona, CA 92879-3121
Phone (951) 737-1917

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121126000504 CA Part B Supplier - Clinic/Group Practice 2668623562 Receives reassigned benefits from 8 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Corona, CA; Temecula, CA; Riverside, CA; Murrieta, CA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1342742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342742400000",
    "number": "1386999829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 MAGNOLIA AVE",
            "address_2": "SUITE 1F",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928793121",
            "telephone_number": "951-737-1917",
            "fax_number": "951-735-4105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41670 IVY ST",
            "address_2": "SUITE C",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925629433",
            "telephone_number": "951-696-5220",
            "fax_number": "951-696-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORANGE PSYCHIATRIC MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-20",
        "last_updated": "2012-07-20",
        "status": "A",
        "authorized_official_last_name": "CHUNDU",
        "authorized_official_first_name": "SAI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT/ OWNER",
        "authorized_official_telephone_number": "951-737-1917",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murrieta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2012; 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.