NPIMap

Organization Active NPI

Pathology Medical Group of Riverside

  • Anatomic Pathology & Clinical Pathology Physician
  • Riverside, CA
National Provider Identifier
1417016833
Registry record updated Nov 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PATHOLOGY MEDICAL GROUP OF RIVERSIDE
Practice address
4445 Magnolia Ave
Riverside Community Hospital
Riverside, CA 92501
Phone
(951) 788-3243
Fax
(951) 788-3633
NPI assigned
Dec 8, 2006
Last updated
Nov 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2019

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

Authorized official

Name
Dr. Darren Okada, MDNPI 1134245921
Title
Owner - Medical Director
Phone
(951) 788-3243

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X NU Primary

Addresses

Primary practice location

4445 Magnolia Ave
Riverside Community Hospital
Riverside, CA 92501

Mailing address

PO Box 260071
Saint Louis, MO 63126-8071
Phone (314) 849-3535

Other identifiers 1

IdentifierTypeStateIssuer
GR0087630MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050621001005 CA Part B Supplier - Clinic/Group Practice 2466497425 Receives reassigned benefits from 4 practitioners
Practice locations: Riverside, CA

National Provider Directory

National Provider Directory

Locations

4445 Magnolia Ave
Ste M12
Riverside, CA 92501

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574812800000",
    "number": "1417016833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 260071",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631268071",
            "telephone_number": "314-849-3535",
            "fax_number": "844-410-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 MAGNOLIA AVE",
            "address_2": "RIVERSIDE COMMUNITY HOSPITAL",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92501",
            "telephone_number": "951-788-3243",
            "fax_number": "951-788-3633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATHOLOGY MEDICAL GROUP OF RIVERSIDE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2019-11-27",
        "status": "A",
        "authorized_official_last_name": "OKADA",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "OWNER - MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "951-788-3243",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0087630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2019; 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.