NPIMap

Individual provider Active NPI

Luther Mangoba, M.D.

  • Family Medicine Physician
  • Riverside, CA
National Provider Identifier
1528041894
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A77574 Issued in CA
Practice address
9041 Magnolia Ave
Suite 008
Riverside, CA 92503-3900
Phone
(951) 687-0004
Fax
(951) 687-0080
NPI assigned
Nov 21, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A77574 CA Primary

Addresses

Primary practice location

9041 Magnolia Ave
Suite 008
Riverside, CA 92503-3900

Mailing address

9041 Magnolia Ave
Suite 008
Riverside, CA 92503-3900
Phone (951) 687-0004

Other identifiers 2

IdentifierTypeStateIssuer
00A775740MedicaidCA
A77574OtherCASTATE LICENCSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050202000963 CA Practitioner - Family Practice 2466403860 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advanced Care Medical IncGroup PAC ID 7517385792, 2 clinicians
Family Choice Aco IncGroup PAC ID 7719379395, 60 clinicians
Luther Mangoba, MD Inc.Group PAC ID 9537292594, 4 clinicians

Practice addresses (Care Compare)

400 Newport Ctr Dr
Suite 301
Newport Beach, CA 92660-7604
Phone (949) 644-1300

7631 Wyoming St
Suite 201
Westminster, CA 92683-3904
Phone (714) 898-0765

9041 Magnolia Ave
Suite 8
Riverside, CA 92503-3941
Phone (951) 687-0004

Hospital & facility affiliations

  • Hoag Home Health Home health agency, Newport Beach, CA, CCN 557412
  • Affinity Home Health Care Services, Inc Home health agency, Riverside, CA, CCN 059026
  • St. Mary'S Hospice, Inc Hospice, Diamond Bar, CA, CCN 751791
  • Riverside Postacute Care Nursing home, Riverside, CA, CCN 555330
  • Jurupa Hills Post Acute Nursing home, Riverside, CA, CCN 055581
  • Riverside Heights Healthcare Center, LLC Nursing home, Riverside, CA, CCN 555884
  • Citrus Grove Post Acute Nursing home, Riverside, CA, CCN 056315

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A77574CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lawrence Y Lo MD Inc CurrentSince Jun 17, 2020 Accepting new patients
Luther Mangoba, MD Inc. Family Medicine CurrentSince Apr 6, 2010 Accepting new patients
Aligned Community Physicians Current Accepting new patients
Advanced Care Medical Inc Family Medicine CurrentSince Jun 17, 2020 Accepting new patients
Family Choice Aco Inc CurrentSince May 4, 2024 Accepting new patients
Allergy, Sinus & Asthma Consultants Inc. PastSince Jan 1, 2001 Accepting new patients
Care Community, P.C. Family Medicine Past Accepting new patients
Grace Medical and Wellness Clinic PastSince Aug 16, 2023 Accepting new patients

Locations

400 Newport Center Dr
Ste 303
Newport Beach, CA 92660

400 Newport Center Dr
Ste 301
Newport Beach, CA 92660
Phone (949) 644-1300

6377 Riverside Ave
Ste B101
Riverside, CA 92506
Phone (951) 686-0004

9041 Magnolia Ave
Ste 8
Riverside, CA 92503
Phone (951) 686-0004

7631 Wyoming St
Ste 201
Westminster, CA 92683
Phone (714) 898-0765

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • FHIR API: https://api.platform.athenahealth.com/12935/brand/1/csg/1/fhir/r4

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jurupa Hills Post AcuteRiverside, CA, CCN 055581 Skilled nursing facility Contracted Managing Employee Jun 30, 2015
Arrowhead Springs HealthcareSan Bernardino, CA, CCN 055708 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Feb 1, 2022
Feb 1, 2022
St Mary'S Hospice IncDiamond Bar, CA, CCN 751791 Hospice 5% Or Greater Direct Ownership Interest (10%)
Corporate Officer (10%)
Corporate Director (10%)
W-2 Managing Employee		 Jan 2, 2020
Jun 30, 2025
Jun 30, 2025
Jan 26, 2021

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1528041894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9041 MAGNOLIA AVE",
            "address_2": "SUITE 008",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033900",
            "telephone_number": "951-687-0004",
            "fax_number": "951-687-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9041 MAGNOLIA AVE",
            "address_2": "SUITE 008",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033900",
            "telephone_number": "951-687-0004",
            "fax_number": "951-687-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGOBA",
        "first_name": "LUTHER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-21",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A77574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A775740",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCSE",
            "identifier": "A77574",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.