NPIMap

Organization Active NPI

Inland Valley Trauma and Acute Care Surgery Apc Inc

  • Surgery Physician
  • Wildomar, CA
National Provider Identifier
1417448168
Registry record updated Jun 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
INLAND VALLEY TRAUMA AND ACUTE CARE SURGERY APC INC
Practice address
36320 Inland Valley Dr Ste 101a
Wildomar, CA 92595
Phone
(951) 698-3000
Fax
(951) 698-7700
NPI assigned
May 29, 2018
Last updated
Jun 18, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2018

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

Authorized official

Name
Dr. Tito Flavio Gorski, MDNPI 1508958240
Title
Ceo President
Phone
(951) 331-9040

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
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

36320 Inland Valley Dr Ste 101a
Wildomar, CA 92595

Mailing address

36320 Inland Valley Dr Ste 101a
Wildomar, CA 92595-7512
Phone (951) 698-3000

Other identifiers 1

IdentifierTypeStateIssuer
1508958240OtherCANPI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180618002839 CA Part B Supplier - Clinic/Group Practice 9830444751 Receives reassigned benefits from 15 practitioners
Practice locations: Wildomar, CA

National Provider Directory

National Provider Directory

Locations

36320 Inland Valley Dr
Ste 101
Wildomar, CA 92595
Phone (951) 600-3811

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529280000000",
    "number": "1417448168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36320 INLAND VALLEY DR STE 101A",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957512",
            "telephone_number": "951-698-3000",
            "fax_number": "951-698-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36320 INLAND VALLEY DR STE 101A",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "92595",
            "telephone_number": "951-698-3000",
            "fax_number": "951-698-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INLAND VALLEY TRAUMA AND ACUTE CARE SURGERY APC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-29",
        "last_updated": "2018-06-18",
        "status": "A",
        "authorized_official_last_name": "GORSKI",
        "authorized_official_first_name": "TITO",
        "authorized_official_middle_name": "FLAVIO",
        "authorized_official_title_or_position": "CEO PRESIDENT",
        "authorized_official_telephone_number": "951-331-9040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1508958240",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildomar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; 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.