NPIMap

Organization Active NPI

Inland Psychiatric Medical Group, Inc.

  • Psychiatry Physician
  • Hesperia, CA
National Provider Identifier
1588091169
Registry record updated Nov 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
INLAND PSYCHIATRIC MEDICAL GROUP, INC.
Practice address
16279 Walnut St
Hesperia, CA 92345-3622
Phone
(760) 947-0070
Fax
(760) 947-3494
NPI assigned
Sep 27, 2013
Last updated
Nov 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2018

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

Authorized official

Name
Gloria Arzate
Title
Credentialing
Phone
(909) 289-4075

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Clinical Psychologist 103TC0700X NU
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X NU
Psychiatry Physician 2084P0800X NU Primary

Addresses

Primary practice location

16279 Walnut St
Hesperia, CA 92345-3622

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
O20031106000736 CA Part B Supplier - Clinic/Group Practice 9436062312 Receives reassigned benefits from 192 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moreno Valley, CA; Palm Desert, CA; Rancho Cucamonga, CA; Hemet, CA; Redlands, CA; Riverside, CA; San Bernardino, CA; San Juan Capistrano, CA…

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Inland Psychiatric Medical Group Inc39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

2372 Sterling Ave
Sn Bernrdno, CA 92404
Phone (909) 422-8029

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 12

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": "1380240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1588091169",
    "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": "16279 WALNUT ST",
            "city": "HESPERIA",
            "state": "CA",
            "postal_code": "923453622",
            "telephone_number": "760-947-0070",
            "fax_number": "760-947-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INLAND PSYCHIATRIC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-27",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "ARZATE",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "909-289-4075"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hesperia, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; 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.