St Joseph Multi-Specialty Clinic Corp

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ST JOSEPH MULTI-SPECIALTY CLINIC CORP

Practice address

1557 E Amar Rd Ste F
West Covina, CA 91792-1678

Phone

(626) 839-9100

NPI assigned

Feb 9, 2020

Organization subpart

No

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

Authorized official

Name

Shura A Moreno, MDNPI 1174542716

Title

Medical Director

Phone

(626) 839-9100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 4

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.

• Shura A Moreno, MD

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1174542716
  Medicare reassignment Care Compare group NPD Authorized official
• Jane Herico, N.P.

  • Nurse Practitioner
  • Riverside, CA
  • NPI 1699191643
  Medicare reassignment Care Compare group NPD
• Rodolfo Pernia Castro, NP

  • Family Nurse Practitioner
  • West Covina, CA
  • NPI 1689984320
  Medicare reassignment NPD
• Joanna Reina Mayonte Reyes, NP-C

  • Family Nurse Practitioner
  • West Covina, CA
  • NPI 1316373293
  Medicare reassignment NPD

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

{
    "created_epoch": "1581206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581206400000",
    "number": "1487286316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1557 E AMAR RD STE F",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917921678",
            "telephone_number": "626-839-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1557 E AMAR RD STE F",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917921678",
            "telephone_number": "626-839-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH MULTI-SPECIALTY CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-09",
        "last_updated": "2020-02-09",
        "certification_date": "2020-02-09",
        "status": "A",
        "authorized_official_last_name": "MORENO",
        "authorized_official_first_name": "SHURA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "626-839-9100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in West Covina, CA
• Providers in West Covina, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2020; 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.