Premium Extremity Care, Inc.

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

Legal business name

PREMIUM EXTREMITY CARE, INC.

Practice address

843 E Foothill Blvd
Upland, CA 91786-4034

Phone

(909) 982-1002

NPI assigned

Aug 9, 2022

Organization subpart

No

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

Authorized official

Name

Ali Heidari, DONPI 1962516351

Title

Owner/Ceo

Phone

(909) 982-1002

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ali Heidari, D.O.

  • Specialist
  • Upland, CA
  • NPI 1962516351
  NPD Authorized official

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

{
    "created_epoch": "1660003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660003200000",
    "number": "1427786367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "843 E FOOTHILL BLVD",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864034",
            "telephone_number": "909-982-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "843 E FOOTHILL BLVD",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864034",
            "telephone_number": "909-982-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM EXTREMITY CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-09",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "HEIDARI",
        "authorized_official_first_name": "ALI",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "909-982-1002",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Tobe Primicerio

• Plastic Surgery Physician in Upland, CA
• Providers in Upland, CA by specialty
• Plastic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.