Organization Active NPI

San Antonio Urology Medical Group Inc

  • Urology Physician
  • Upland, CA
National Provider Identifier
1497948491
Registry record updated Mar 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
SAN ANTONIO UROLOGY MEDICAL GROUP INC
Practice address
1175 E Arrow Hwy
Suite E
Upland, CA 91786-5525
Phone
(909) 985-9737
Fax
(909) 981-1203
NPI assigned
Aug 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2015

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

Authorized official

Name
John U Alvarez
Title
Billing Manager
Phone
(909) 949-8866

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

1175 E Arrow Hwy
Suite E
Upland, CA 91786-5525

Mailing address

1175 E Arrow Hwy
Suite E
Upland, CA 91786-5525
Phone (909) 985-9737

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071210000601 CA Part B Supplier - Clinic/Group Practice 7719076017 Receives reassigned benefits from 3 practitioners
Practice locations: Pomona, CA; Upland, CA

National Provider Directory

National Provider Directory

Locations

1113 Alta Ave
Ste 110
Upland, CA 91786
Phone (909) 949-8000

1175 E Arrow Hwy
Ste E
Upland, CA 91786
Phone (909) 623-3428

Practitioners & affiliated clinicians

Practitioners 3

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": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426464000000",
    "number": "1497948491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 E ARROW HWY",
            "address_2": "SUITE E",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865525",
            "telephone_number": "909-985-9737",
            "fax_number": "909-981-1203"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 E ARROW HWY",
            "address_2": "SUITE E",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865525",
            "telephone_number": "909-985-9737",
            "fax_number": "909-981-1203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN ANTONIO UROLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2015-03-16",
        "status": "A",
        "authorized_official_last_name": "ALVAREZ",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "909-949-8866"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; 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.