NPIMap

Organization Active NPI

Cardiology Specialists Medical Group, Inc.

  • Specialist
  • Riverside, CA
National Provider Identifier
1467487983
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A43218 Issued in CA
Legal business name
CARDIOLOGY SPECIALISTS MEDICAL GROUP, INC.
Practice address
3770 Elizabeth St
Riverside, CA 92506-2527
Phone
(951) 352-3937
Fax
(951) 352-2839
NPI assigned
Jul 12, 2006
Last updated
Jan 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

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

Authorized official

Name
Dr. Kaustubh Vasant Patankar, M.D.NPI 1083635593
Title
President
Phone
(951) 352-3937

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A43218 CA Primary

Addresses

Primary practice location

3770 Elizabeth St
Riverside, CA 92506-2527

Mailing address

3770 Elizabeth St
Riverside, CA 92506-2527
Phone (951) 352-3937

Other practice location 1

3975 Jackson St
309
Riverside, CA 92503-3901
Phone (951) 352-3937

Other identifiers 1

IdentifierTypeStateIssuer
CA236270OtherCAPTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040828000247 CA Part B Supplier - Clinic/Group Practice 9830164359 Receives reassigned benefits from 12 practitioners
Practice locations: Temecula, CA; San Bernardino, CA; Hemet, CA; Riverside, CA; Perris, CA; Murrieta, CA; Montclair, CA; Corona, CA…

National Provider Directory

National Provider Directory

Locations

264 N Highland Springs Ave
Ste 1
Banning, CA 92220

264 N Highland Springs Ave
Ste 2D
Banning, CA 92220
Phone (951) 769-0018

845 Highland Springs Ave
#300
Beaumont, CA 92223

818 Magnolia Ave
Ste 301
Corona, CA 92879

830 Magnolia Ave
Ste 101
Corona, CA 92879

706 S Main Ave
Fallbrook, CA 92028
Phone (760) 451-3500

3853 W Stetson Ave
Ste 104
Hemet, CA 92545

28078 Baxter Rd
Ste 110
Murrieta, CA 92563
Phone (909) 558-2799

39755 Murrieta Hot Springs Rd
#G
Murrieta, CA 92563

39755 Murrieta Hot Springs Rd
Bldg G
Murrieta, CA 92563

3975 Jackson St
Ste 309
Riverside, CA 92503

4244 Riverwalk Pkwy
Ste 150
Riverside, CA 92505
Phone (951) 335-4660

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1467487983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3770 ELIZABETH ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062527",
            "telephone_number": "951-352-3937",
            "fax_number": "951-352-2839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3770 ELIZABETH ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062527",
            "telephone_number": "951-352-3937",
            "fax_number": "951-352-2839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3975 Jackson St",
            "address_2": "309",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "925033901",
            "country_code": "US",
            "telephone_number": "951-352-3937",
            "fax_number": "951-352-2839",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CARDIOLOGY SPECIALISTS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2023-01-24",
        "certification_date": "2022-04-14",
        "status": "A",
        "authorized_official_last_name": "PATANKAR",
        "authorized_official_first_name": "KAUSTUBH",
        "authorized_official_middle_name": "VASANT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-352-3937",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A43218",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN",
            "identifier": "CA236270",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 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.