NPIMap

Organization Active NPI

Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
National Provider Identifier
1639715709
Registry record updated Jan 6, 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
Anaheim, CA 92805-3960
Phone
(147) 123-5007
NPI assigned
Nov 22, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 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
Anaheim, CA 92805-3960

Mailing address

PO Box 31001 - 1920
Pasadena, CA 91110-1920
Phone (714) 449-4800

Other names 1

  • St Joseph Heritage Healthcare 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 48)

5630 E Santa Ana Canyon Rd
Anaheim, CA 92807
Phone (714) 257-6170

18310 US Highway 18
Ste 100
Apple Valley, CA 92307
Phone (760) 240-5505

1200 Marshall St
Crescent City, CA 95531
Phone (707) 465-1126

1773 Harrison Ave
#A
Eureka, CA 95501
Phone (707) 269-3671

2200 Harrison Ave
Ste D
Eureka, CA 95501
Phone (707) 444-6011

1773 Harrison Ave
Ste A
Eureka, CA 95501

2280 Harrison Ave
Ste C
Eureka, CA 95501
Phone (707) 443-9371

2828 Oneil Ln
Ste A
Eureka, CA 95503
Phone (707) 443-9385

2280 Harrison Ave
Ste A
Eureka, CA 95501
Phone (707) 443-9371

2828 Oneil Ln
Eureka, CA 95503
Phone (707) 443-9385

2280 Harrison Ave
Ste D
Eureka, CA 95501
Phone (707) 443-9371

26795 Portola Pkwy
Foothill Ranch, CA 92610
Phone (949) 829-9403

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

501 N Cornell Ave
Ste 1
Fullerton, CA 92831
Phone (714) 992-2730

1950 Sunny Crest Dr
Ste 2500
Fullerton, CA 92835
Phone (714) 263-9383

2141 N Harbor Blvd
Ste 350
Fullerton, CA 92835
Phone (714) 449-4841

2141 N Harbor Blvd
#250
Fullerton, CA 92835
Phone (714) 449-4841

17061 Main St
Hesperia, CA 92345
Phone (760) 956-4126

17043 Main St
Hesperia, CA 92345

19582 Beach Blvd
Ste 210
Huntington Beach, CA 92648
Phone (714) 477-8001

19582 Beach Blvd
Ste 350
Huntington Beach, CA 92648
Phone (714) 477-8001

57 Prism
#B
Irvine, CA 92618
Phone (949) 430-3960

17585 Harvard Ave
Ste D2
Irvine, CA 92614
Phone (949) 517-9655

57 Prism
Irvine, CA 92618
Phone (818) 847-6881

52 Discovery
Irvine, CA 92618
Phone (949) 297-7748

Practitioners & affiliated clinicians

Practitioners 1,709

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 1,709

NPI Registry JSON

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

{
    "created_epoch": "1574380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767657600000",
    "number": "1639715709",
    "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": "714-449-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W CENTER STREET PROMENADE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928053960",
            "telephone_number": "147-123-5007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE MEDICAL FOUNDATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-22",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Joseph Heritage Healthcare",
            "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 Jan 6, 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.