NPIMap

Organization Active NPI

Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
National Provider Identifier
1609925957
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PROVIDENCE MEDICAL FOUNDATION
Practice address
200 W Center Street Promenade Ste 100
Anaheim, CA 92805-3960
Phone
(714) 449-4841
NPI assigned
Jan 9, 2007
Last updated
Feb 3, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Authorized official

Name
Donald W. Anderson Jr.
Title
Assistant Secretary of Enrollments
Phone
(425) 358-9786

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

200 W Center Street Promenade Ste 100
Anaheim, CA 92805-3960

Mailing address

PO Box 31001 - 1920
Pasadena, CA 91110-1920
Phone (714) 449-4841

Other identifiers 3

IdentifierTypeStateIssuer
GR0085350MedicaidCA
GR0085353MedicaidCA
GR0085351MedicaidCA

Other names 2

  • St Joseph Heritage Healthcare Former legal business name
  • St Jude Hospital Yorba Linda Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040216001346 CA Part B Supplier - Clinic/Group Practice 8921993205 Receives reassigned benefits from 1,892 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Locations (25 of 53)

26671 Aliso Creek Rd
Ste 202
Aliso Viejo, CA 92656
Phone (949) 791-3105

200 W Ctr St Promenade
Ste 100
Anaheim, CA 92805
Phone (714) 449-4841

5630 E Santa Ana Canyon Rd
Ste 1
Anaheim, CA 92807

5634 E Santa Ana Cyn Rd
Anaheim, CA 92807

955 W Imperial Hwy
Ste 200
Brea, CA 92821
Phone (714) 449-6900

2350 Buhne St
Ste C
Eureka, CA 95501
Phone (707) 444-8863

2460 Buhne St
Ste C
Eureka, CA 95501

2752 Harrison Ave
#B
Eureka, CA 95501
Phone (707) 443-7877

3300 Renner Dr
#D
Fortuna, CA 95540

100 E Valencia Mesa Dr
Ste 300
Fullerton, CA 92835
Phone (714) 738-4282

17083 Main St
Hesperia, CA 92345

21034 Pacific Coast Hwy
#C230
Huntington Beach, CA 92648

5341 Warner Ave
Huntington Beach, CA 92649
Phone (714) 477-8450

15785 Laguna Canyon Rd
Ste 100
Irvine, CA 92618
Phone (949) 364-2900

16205 Sand Canyon Ave
Bldg D
Irvine, CA 92618

3850 Barranca Pkwy
Ste Kl
Irvine, CA 92606
Phone (949) 899-8309

3850 Barranca Pkwy
Ste Kll
Irvine, CA 92606

600 Corporate Dr
Ste 210
Ladera Ranch, CA 92694
Phone (949) 364-2481

27731 La Paz Rd Ste a
Laguna Niguel, CA 92677

28202 Cabot Rd
Ste 105
Laguna Niguel, CA 92677
Phone (949) 364-2900

22621 Lake Forest Dr
Ste 1
Lake Forest, CA 92630

26800 Crown Valley Pkwy
Ste 275
Mission Viejo, CA 92691
Phone (949) 542-8002

27871 Medical Center Rd
Ste 200
Mission Viejo, CA 92691
Phone (949) 347-8314

1100 Trancas St
Ste 210
Napa, CA 94558
Phone (707) 251-3608

1100 Trancas St
Ste 212A
Napa, CA 94558

Practitioners & affiliated clinicians

Practitioners 274

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.

View all 274

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770076800000",
    "number": "1609925957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31001 - 1920",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911101920",
            "telephone_number": "714-449-4841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W CENTER STREET PROMENADE STE 100",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928053960",
            "telephone_number": "714-449-4841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
        "authorized_official_telephone_number": "425-358-9786",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0085350",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0085353",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0085351",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Joseph Heritage Healthcare",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "St Jude Hospital Yorba Linda",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2026; 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.