NPIMap

Organization Active NPI

Oc Geropsychiatric Medical Group

  • Geriatric Psychiatry Physician
  • Jurupa Valley, CA
National Provider Identifier
1548003015
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Psychiatry PhysicianTaxonomy code 2084P0805X
Legal business name
OC GEROPSYCHIATRIC MEDICAL GROUP
Practice address
6000 Camino Real
Suite B
Jurupa Valley, CA 92509
Phone
(714) 487-9724
NPI assigned
Jun 13, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Thu Phan, NPNPI 1245779016
Title
Director, Secretary, and Treasurer
Phone
(714) 487-9724

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
Geriatric Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0805X Primary

Addresses

Primary practice location

6000 Camino Real
Suite B
Jurupa Valley, CA 92509

Mailing address

16478 Beach Blvd
Westminster, CA 92683-7860
Phone (714) 487-9724

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240924001100 CA Part B Supplier - Clinic/Group Practice 0648711168 Receives reassigned benefits from 7 practitioners
Practice locations: Brea, CA; Dana Point, CA; Fountain Valley, CA; Huntington Beach, CA; Laguna Hills, CA; Rancho Mission Viejo, CA

National Provider Directory

National Provider Directory

Locations

6000 Camino Real
Ste B
Jurupa Valley, CA 92509
Phone (714) 487-9724

Practitioners & affiliated clinicians

Practitioners 7

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": "1718236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1548003015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16478 BEACH BLVD",
            "city": "WESTMINSTER",
            "state": "CA",
            "postal_code": "926837860",
            "telephone_number": "714-487-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 CAMINO REAL",
            "address_2": "SUITE B",
            "city": "JURUPA VALLEY",
            "state": "CA",
            "postal_code": "92509",
            "telephone_number": "714-487-9724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OC GEROPSYCHIATRIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-06",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "THU",
        "authorized_official_title_or_position": "DIRECTOR, SECRETARY, AND TREASURER",
        "authorized_official_telephone_number": "714-487-9724",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "2084P0805X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jurupa Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 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.