NPIMap

Organization Active NPI

Performance Medical Group

  • General Practice Physician
  • Apple Valley, CA
National Provider Identifier
1629314661
Registry record updated Dec 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PERFORMANCE MEDICAL GROUP
Practice address
16130 Kokanee Rd Ste 101
Apple Valley, CA 92307-0833
Phone
(760) 242-5055
Fax
(760) 242-5466
NPI assigned
Dec 19, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2012

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

Authorized official

Name
Lee Freire
Title
Office Manager
Phone
(760) 242-5055

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
AcupuncturistGroup: 193200000X MULTI-SPECIALTY GROUP 171100000X
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X
Orthopaedic Foot and Ankle Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0004X
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

16130 Kokanee Rd Ste 101
Apple Valley, CA 92307-0833

Mailing address

16130 Kokanee Rd Ste 101
Apple Valley, CA 92307-0833
Phone (760) 242-5055

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1355875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355875200000",
    "number": "1629314661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16130 KOKANEE RD STE 101",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923070833",
            "telephone_number": "760-242-5055",
            "fax_number": "760-242-5466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16130 KOKANEE RD STE 101",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923070833",
            "telephone_number": "760-242-5055",
            "fax_number": "760-242-5466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-19",
        "last_updated": "2012-12-19",
        "status": "A",
        "authorized_official_last_name": "FREIRE",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "760-242-5055"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0004X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Foot and Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; 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.