NPIMap

Organization Active NPI

Southern California Emergency Medicine

Doing business as Moreno Beach Urgent Care Center

  • Urgent Care Clinic/Center
  • Moreno Valley, CA
National Provider Identifier
1518380765
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
License
A73011 Issued in CA
Legal business name
SOUTHERN CALIFORNIA EMERGENCY MEDICINE
Doing business as
Moreno Beach Urgent Care Center
Practice address
27640 Eucalyptus Ave
Suite # 4
Moreno Valley, CA 92555-4557
Phone
(909) 596-6349
NPI assigned
Jan 23, 2014
Last updated
Jan 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

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

Authorized official

Name
Mrs. Jennifer Brunk
Title
Credentialing Manager
Phone
(909) 596-6349

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X A73011 CA Primary

Addresses

Primary practice location

27640 Eucalyptus Ave
Suite # 4
Moreno Valley, CA 92555-4557

Mailing address

1407 Foothill Blvd # 306
La Verne, CA 91750-3451
Phone (909) 596-6349

Other names 1

  • Moreno Beach Urgent Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090604000499 CA Part B Supplier - Clinic/Group Practice 8628128196 Receives reassigned benefits from 89 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hemet, CA; Moreno Valley, CA; Norco, CA; Redlands, CA; Riverside, CA; San Bernardino, CA; Yucaipa, CA; Colton, CA

Other NPIs on the same Medicare enrollment 7

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2083694Moreno Beach Urgent Care Center27640 Eucalyptus Ave, Moreno Valley, CA 92555Certificate of waiverSep 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Southern California Emergency Medicine5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

4240 Highland Ave
Ste B
Highland, CA 92346
Phone (909) 864-4700

27640 Eucalyptus Ave
Ste 4
Moreno Valley, CA 92555
Phone (909) 596-6349

Practitioners & affiliated clinicians

Practitioners 10

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": "1390435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390435200000",
    "number": "1518380765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 FOOTHILL BLVD # 306",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917503451",
            "telephone_number": "909-596-6349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27640 EUCALYPTUS AVE",
            "address_2": "SUITE # 4",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925554557",
            "telephone_number": "909-596-6349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA EMERGENCY MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-23",
        "last_updated": "2014-01-23",
        "status": "A",
        "authorized_official_last_name": "BRUNK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "909-596-6349",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "A73011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Moreno Beach Urgent Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moreno Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; 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.