Organization Active NPI

Idyllwild Health Center

  • Internal Medicine Physician
  • Idyllwild, CA
National Provider Identifier
1407964489
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
IDYLLWILD HEALTH CENTER
Practice address
54910 Pinecrest Ave
Idyllwild, CA 92549
Phone
(951) 659-4908
Fax
(951) 659-2984
NPI assigned
Aug 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Kamran Qureshi, M.D.NPI 1326156472
Title
President
Phone
(951) 659-4908

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

54910 Pinecrest Ave
Idyllwild, CA 92549

Mailing address

PO Box 3152
Idyllwild, CA 92549-3152
Phone (951) 659-4908

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050629000632 CA Part B Supplier - Clinic/Group Practice 1153367289 Receives reassigned benefits from 2 practitioners
Practice locations: Idyllwild, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1407964489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3152",
            "city": "IDYLLWILD",
            "state": "CA",
            "postal_code": "925493152",
            "telephone_number": "951-659-4908",
            "fax_number": "951-659-2984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54910 PINECREST AVE",
            "city": "IDYLLWILD",
            "state": "CA",
            "postal_code": "92549",
            "telephone_number": "951-659-4908",
            "fax_number": "951-659-2984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDYLLWILD HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "QURESHI",
        "authorized_official_first_name": "KAMRAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-659-4908",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idyllwild, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.