Organization Active NPI

Our Family Medical Group, Inc.

  • Internal Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1437601879
Registry record updated Nov 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
OUR FAMILY MEDICAL GROUP, INC.
Practice address
9190 Haven Ave Ste 102
Rancho Cucamonga, CA 91730-5431
Phone
(909) 981-0989
Fax
(909) 949-6214
NPI assigned
Nov 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2025

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

Authorized official

Name
Ewa H KoncaNPI 1134197528
Title
Physician
Phone
(909) 981-0989

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
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X

Addresses

Primary practice location

9190 Haven Ave Ste 102
Rancho Cucamonga, CA 91730-5431

Mailing address

840 Towne Center Dr
Pomona, CA 91767-5900
Phone (909) 398-1550

Other practice location 1

1131 W 6th St Ste 150
Ontario, CA 91762-1116
Phone (909) 482-4462

Other practice location 2

5475 Walnut Ave Ste H
Chino, CA 91710-2609
Phone (909) 591-6446

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170106001779 CA Part B Supplier - Clinic/Group Practice 8729369665 Receives reassigned benefits from 10 practitioners
4 other NPIs on this enrollment
Practice locations: Chino, CA; Ontario, CA; Rancho Cucamonga, CA

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2141990Our Family Medical Group, Inc9190 Haven Ave 102, Rancho Cucamonga, CA 91730Certificate of waiverDec 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Our Family Medical Group4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5475 Walnut Ave
Ste H
Chino, CA 91710
Phone (909) 591-6446

Practitioners & affiliated clinicians

Practitioners 12

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": "1478044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762992000000",
    "number": "1437601879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 TOWNE CENTER DR",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675900",
            "telephone_number": "909-398-1550",
            "fax_number": "909-398-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9190 HAVEN AVE STE 102",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305431",
            "telephone_number": "909-981-0989",
            "fax_number": "909-949-6214"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1131 W 6th St Ste 150",
            "address_purpose": "LOCATION",
            "city": "Ontario",
            "state": "CA",
            "postal_code": "917621116",
            "country_code": "US",
            "telephone_number": "909-482-4462",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5475 Walnut Ave Ste H",
            "address_purpose": "LOCATION",
            "city": "Chino",
            "state": "CA",
            "postal_code": "917102609",
            "country_code": "US",
            "telephone_number": "909-591-6446",
            "fax_number": "909-591-1309",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OUR FAMILY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-02",
        "last_updated": "2025-11-13",
        "certification_date": "2025-11-13",
        "status": "A",
        "authorized_official_last_name": "KONCA",
        "authorized_official_first_name": "EWA",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "909-981-0989"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2025; 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.