NPIMap

Organization Active NPI

Lasalle Medical Associates

  • Multi-Specialty Clinic/Center
  • San Bernardino, CA
National Provider Identifier
1447388251
Registry record updated Aug 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
License
A38206 Issued in CA
Legal business name
LASALLE MEDICAL ASSOCIATES
Practice address
565 N. Mt. Vernon Ave.
San Bernardino, CA 92411-2661
Phone
(909) 884-9091
Fax
(909) 383-7013
NPI assigned
Mar 1, 2007
Last updated
Aug 23, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2016

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

Authorized official

Name
Albert H. Arteaga, M.D.NPI 1942398482
Title
Ceo/Owner
Phone
(909) 890-0407

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Multi-Specialty Clinic/Center 261QM1300X A38206 CA Primary
Multi-Specialty Clinic/Center 261QM1300X A31849 CA

Addresses

Primary practice location

565 N. Mt. Vernon Ave.
San Bernardino, CA 92411-2661

Mailing address

1855 W Redlands Blvd
2ND Floor
Redlands, CA 92373-3145
Phone (909) 890-0407

Other identifiers 4

IdentifierTypeStateIssuer
P00014299OtherCARR MEDICARE PIN
GR0079095MedicaidCA
00A382060OtherCAMEDI-CAL ID NUMBER
P00014299OtherCARAILROAD MEDICARE UPIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050506000376 CA Part B Supplier - Clinic/Group Practice 1557301744 Receives reassigned benefits from 8 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fontana, CA; Hesperia, CA; Rialto, CA; San Bernardino, CA; Victorville, CA

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Lasalle Medical Associates7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

565 N Mount Vernon Ave
Sn Bernrdno, CA 92411
Phone (909) 884-9091

Practitioners & affiliated clinicians

Practitioners 3

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": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471910400000",
    "number": "1447388251",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1855 W REDLANDS BLVD",
            "address_2": "2ND FLOOR",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923733145",
            "telephone_number": "909-890-0407",
            "fax_number": "909-890-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 N. MT. VERNON AVE.",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924112661",
            "telephone_number": "909-884-9091",
            "fax_number": "909-383-7013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LASALLE MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2016-08-23",
        "status": "A",
        "authorized_official_last_name": "ARTEAGA",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "CEO/OWNER",
        "authorized_official_telephone_number": "909-890-0407",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "A38206",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "A31849",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "P00014299",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0079095",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL ID NUMBER",
            "identifier": "00A382060",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE UPIN",
            "identifier": "P00014299",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2016; 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.