NPIMap

Organization Active NPI

Inland Physicians Primary Care Services

  • Internal Medicine Physician
  • Montclair, CA
National Provider Identifier
1457943151
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INLAND PHYSICIANS PRIMARY CARE SERVICES
Practice address
9525 Monte Vista Ave Ste 105
Montclair, CA 91763-2231
Phone
(909) 626-1205
Fax
(909) 625-1977
NPI assigned
Feb 4, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
Shahram Khorrami, MD
Title
Partner
Phone
(909) 626-1205

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

9525 Monte Vista Ave Ste 105
Montclair, CA 91763-2231

Mailing address

9525 Monte Vista Ave Ste 105
Montclair, CA 91763-2231
Phone (909) 626-1205

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210728003434 CA Part B Supplier - Clinic/Group Practice 4385047380 Receives reassigned benefits from 10 practitioners
Practice locations: Montclair, CA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

9625 Monte Vista Ave
Ste 105
Montclair, CA 91763

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": "1612396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1457943151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9525 MONTE VISTA AVE STE 105",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632231",
            "telephone_number": "909-626-1205",
            "fax_number": "909-625-1977"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9525 MONTE VISTA AVE STE 105",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632231",
            "telephone_number": "909-626-1205",
            "fax_number": "909-625-1977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INLAND PHYSICIANS PRIMARY CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-04",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "KHORRAMI",
        "authorized_official_first_name": "SHAHRAM",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "909-626-1205",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2023; 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.