NPIMap

Organization Active NPI

Fenix Health Medical Group, Inc.

  • Family Medicine Physician
  • Pomona, CA
National Provider Identifier
1487075578
Registry record updated Dec 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G072538 Issued in CA
Legal business name
FENIX HEALTH MEDICAL GROUP, INC.
Practice address
716 East Mission Blvd.
Pomona, CA 91766
Phone
(909) 865-2332
Fax
(909) 868-7129
NPI assigned
Dec 17, 2013
Last updated
Dec 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2013

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

Authorized official

Name
Luis Perez, M.D.NPI 1225099880
Title
President
Phone
(909) 865-2322

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X G072538 CA Primary

Addresses

Primary practice location

716 East Mission Blvd.
Pomona, CA 91766

Mailing address

716 East Mission Blvd.
Pomona, CA 91766
Phone (909) 865-2332

National Provider Directory

National Provider Directory

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 2

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": "1387238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387238400000",
    "number": "1487075578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 EAST MISSION BLVD.",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "91766",
            "telephone_number": "909-865-2332",
            "fax_number": "909-868-7129"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 EAST MISSION BLVD.",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "91766",
            "telephone_number": "909-865-2332",
            "fax_number": "909-868-7129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FENIX HEALTH MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-17",
        "last_updated": "2013-12-17",
        "status": "A",
        "authorized_official_last_name": "PEREZ",
        "authorized_official_first_name": "LUIS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-865-2322",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G072538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.