Moreno Valley Community Medical Group

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

MORENO VALLEY COMMUNITY MEDICAL GROUP

Practice address

23180 Hemlock Ave Ste 201
Moreno Valley, CA 92557-8001

Phone

(951) 243-6460

Fax

(951) 243-5871

NPI assigned

May 13, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Joel A Pengson, MDNPI 1720018237

Title

Owner

Phone

(951) 243-6460

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/27911/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/20715/brand/1/csg/1/fhir/r4

Practitioners 7

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

• Joel A Pengson, MD

  • Internal Medicine Physician
  • Moreno Valley, CA
  • NPI 1720018237
  Medicare reassignment Care Compare group Authorized official
• Mallory David, NP

  • Family Nurse Practitioner
  • Moreno Valley, CA
  • NPI 1639925399
  Medicare reassignment Care Compare group NPD
• Allan Concepcion Elarmo, NP

  • Family Nurse Practitioner
  • Moreno Valley, CA
  • NPI 1659705689
  Medicare reassignment Care Compare group
• Shamjana Acharya, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Moreno Valley, CA
  • NPI 1811616642
  Medicare reassignment
• Rosalyn Roncesvalles Elarmo, FNP-C

  • Family Nurse Practitioner
  • Moreno Valley, CA
  • NPI 1922432954
  Medicare reassignment
• Humera Rana, M.D.

  • Internal Medicine Physician
  • Riverside, CA
  • NPI 1801982632
  Medicare reassignment
• Georgina Laus Villacorta, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Riverside, CA
  • NPI 1174192512
  Medicare reassignment

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

{
    "created_epoch": "1368403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650672000000",
    "number": "1437595873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925560220",
            "telephone_number": "951-243-6460",
            "fax_number": "951-243-5871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23180 HEMLOCK AVE STE 201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925578001",
            "telephone_number": "951-243-6460",
            "fax_number": "951-243-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORENO VALLEY COMMUNITY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-13",
        "last_updated": "2022-04-23",
        "certification_date": "2022-04-23",
        "status": "A",
        "authorized_official_last_name": "PENGSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-243-6460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P0018X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1835P1200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Payal Morari, DO
• Daniel Morcos, MD
• Moreno Valley Children'S Interagency Program
• Moreno Valley CMHC
• Moreno Valley Community Hospital
• Moreno Valley Dental Center
• Moreno Valley Dialysis Center
• Moreno Valley Imaging, L.L.C.
• Moreno Valley Med Care LLC
• Moreno Valley Medical Group, Inc

• Multi-Specialty Clinic/Center in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.