NPIMap

Organization Active NPI

California Functional Internal Medicine Clinic LLC

  • Internal Medicine Physician
  • Lake Forest, CA
National Provider Identifier
1609633049
Registry record updated Mar 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CALIFORNIA FUNCTIONAL INTERNAL MEDICINE CLINIC LLC
Practice address
22972 El Toro Rd
Lake Forest, CA 92630-4961
Phone
(816) 585-4373
NPI assigned
Mar 4, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2024

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

Authorized official

Name
Dr. Mohammed W Ansari, MDNPI 1952744948
Title
Managing Member
Phone
(816) 585-4373

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

22972 El Toro Rd
Lake Forest, CA 92630-4961

Mailing address

22972 El Toro Rd
Lake Forest, CA 92630-4961

National Provider Directory

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": "1709510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709510400000",
    "number": "1609633049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22972 EL TORO RD",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926304961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22972 EL TORO RD",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926304961",
            "telephone_number": "816-585-4373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA FUNCTIONAL INTERNAL MEDICINE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-04",
        "last_updated": "2024-03-04",
        "certification_date": "2024-03-02",
        "status": "A",
        "authorized_official_last_name": "ANSARI",
        "authorized_official_first_name": "MOHAMMED",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "816-585-4373",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Forest, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2024; 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.