NPIMap

Organization Active NPI

Irvine Professional Medical Group, Inc

  • Non-Pharmacy Dispensing Site
  • Irvine, CA
National Provider Identifier
1568702835
Registry record updated Feb 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
A107209 Issued in CA
Legal business name
IRVINE PROFESSIONAL MEDICAL GROUP, INC
Doing business as
Irvine Professional Medical Group, Inc
Practice address
3500 Barranca Pkwy
Suite 330
Irvine, CA 92606-8226
Phone
(949) 552-8217
NPI assigned
Feb 25, 2013
Last updated
Feb 25, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2013

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

Authorized official

Name
Kenny Heine
Title
VP Ops
Phone
(858) 964-1506

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X A107209 CA Primary

Addresses

Primary practice location

3500 Barranca Pkwy
Suite 330
Irvine, CA 92606-8226

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705

Other names 1

  • IRVINE PROFESSIONAL MEDICAL GROUP, INC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Irvine Professional Med GRP2 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361750400000",
    "number": "1568702835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 BARRANCA PKWY",
            "address_2": "SUITE 330",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926068226",
            "telephone_number": "949-552-8217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRVINE PROFESSIONAL MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2013-02-25",
        "last_updated": "2013-02-25",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OPS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A107209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IRVINE PROFESSIONAL MEDICAL GROUP, INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.