Organization Active NPI

Montrose Medical Group

  • Family Medicine Physician
  • Montrose, CA
National Provider Identifier
1508575937
Registry record updated Dec 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MONTROSE MEDICAL GROUP
Practice address
2490 Honolulu Ave Ste 128
Montrose, CA 91020-1800
Phone
(510) 300-5473
NPI assigned
Nov 15, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2022

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

Authorized official

Name
Dr. Faisal Uraizee, MDNPI 1295392686
Title
Ceo
Phone
(510) 300-5473

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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2490 Honolulu Ave Ste 128
Montrose, CA 91020-1800

Mailing address

4684 Ariel Ave
Fremont, CA 94555-2008
Phone (510) 300-5473

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL Officeally.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230127000585 CA Part B Supplier - Clinic/Group Practice 6103297254 Receives reassigned benefits from 2 practitioners
Practice locations: Montrose, CA

National Provider Directory

National Provider Directory

Locations

2490 Honolulu Ave
Ste 128
Montrose, CA 91020
Phone (818) 330-9960

2490 Honolulu Ave
Montrose, CA 91020

Practitioners & affiliated clinicians

Practitioners 2

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": "1668470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670716800000",
    "number": "1508575937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4684 ARIEL AVE",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945552008",
            "telephone_number": "510-300-5473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 HONOLULU AVE STE 128",
            "city": "MONTROSE",
            "state": "CA",
            "postal_code": "910201800",
            "telephone_number": "510-300-5473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTROSE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-15",
        "last_updated": "2022-12-11",
        "certification_date": "2022-12-11",
        "status": "A",
        "authorized_official_last_name": "URAIZEE",
        "authorized_official_first_name": "FAISAL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-300-5473",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Officeally.com",
            "affiliation": "N",
            "endpointDescription": "Sofwater",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4290 Honolulu Avenue",
            "address_2": "Ste 128",
            "city": "Montrose",
            "state": "CA",
            "country_code": "US",
            "postal_code": "91020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Montrose, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2022; 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.