NPIMap

Organization Active NPI

Cajon Medical Group PC

  • Internal Medicine Physician
  • San Bernardino, CA
National Provider Identifier
1568052496
Registry record updated Jan 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CAJON MEDICAL GROUP PC
Practice address
1738 N Waterman Ave Ste 7&8
San Bernardino, CA 92404-5131
Phone
(909) 882-1269
Fax
(909) 882-5699
NPI assigned
Jan 25, 2021
Last updated
Jan 25, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2021

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

Authorized official

Name
Nandita Puchakayala, MD
Title
Ceo
Phone
(909) 941-4870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

1738 N Waterman Ave Ste 7&8
San Bernardino, CA 92404-5131

Mailing address

1809 W Redlands Blvd
Redlands, CA 92373-8054

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

Locations

1738 N Waterman Ave
Ste 78
San Bernardino, CA 92404
Phone (909) 882-1269

Practitioners & affiliated clinicians

Practitioners 3

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": "1611532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611532800000",
    "number": "1568052496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 W REDLANDS BLVD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1738 N WATERMAN AVE STE 7&8",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924045131",
            "telephone_number": "909-882-1269",
            "fax_number": "909-882-5699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAJON MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-25",
        "last_updated": "2021-01-25",
        "certification_date": "2021-01-08",
        "status": "A",
        "authorized_official_last_name": "PUCHAKAYALA",
        "authorized_official_first_name": "NANDITA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-941-4870",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2021; 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.