NPIMap

Organization Active NPI

Cajon Medical Group, PC

  • Internal Medicine Physician
  • Lancaster, CA
National Provider Identifier
1508637760
Registry record updated Jan 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CAJON MEDICAL GROUP, PC
Practice address
44725 10TH St W Ste 230
Lancaster, CA 93534-3048
Phone
(909) 735-2446
Fax
(909) 206-1553
NPI assigned
Jan 15, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2024

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

Authorized official

Name
Amber Gutierrez
Title
Provider Relations
Phone
(909) 289-4075

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

44725 10TH St W Ste 230
Lancaster, CA 93534-3048

Mailing address

1815 W Redlands Blvd
Redlands, CA 92373-8054
Phone (909) 289-4075

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190606002315 CA Part B Supplier - Clinic/Group Practice 8820351174 Receives reassigned benefits from 33 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Redlands, CA; Yucaipa, CA; Wildomar, CA; Victorville, CA; Upland, CA; Temecula, CA; San Bernardino, CA; Riverside, CA…

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Cajon Medical Group PC20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1705276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705276800000",
    "number": "1508637760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 W REDLANDS BLVD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738054",
            "telephone_number": "909-289-4075",
            "fax_number": "909-363-8233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44725 10TH ST W STE 230",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935343048",
            "telephone_number": "909-735-2446",
            "fax_number": "909-206-1553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAJON MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-15",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-15",
        "status": "A",
        "authorized_official_last_name": "GUTIERREZ",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "PROVIDER RELATIONS",
        "authorized_official_telephone_number": "909-289-4075"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; 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.