Providence Medical Foundation

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

Last updated

Jan 6, 2026By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• St Joseph Heritage Healthcare Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 10

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

• Providence Medical Foundation

  • Urology Physician
  • Apple Valley, CA
  • NPI 1053616706

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • Obstetrics & Gynecology Physician
  • Napa, CA
  • NPI 1205131950

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • General Practice Physician
  • Diamond Bar, CA
  • NPI 1285890624

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • Family Medicine Physician
  • Mission Viejo, CA
  • NPI 1427305960

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • Surgery Physician
  • Eureka, CA
  • NPI 1477790517

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1609925957

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • Anesthesiology Physician
  • Eureka, CA
  • NPI 1649551086

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • Internal Medicine Physician
  • Santa Rosa, CA
  • NPI 1740584473

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • Hematology & Oncology Physician
  • Orange, CA
  • NPI 1801443510

  O20040216001346

  Same enrollment
• Providence Medical Foundation

  • Family Medicine Physician
  • Brea, CA
  • NPI 1871607762

  O20040216001346

  Same enrollment

Locations (25 of 65)

Practitioners 1,710

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.

• Lea Dominique Maturan Abadies, PA

  • Physician Assistant
  • Tustin, CA
  • NPI 1124754254
  NPD
• Shenoda Yousef Azmy Abd Elmaseh

  • Family Medicine Physician
  • Mission Viejo, CA
  • NPI 1194348656
  NPD
• Abdul Said Fazel Abdali, M.D.

  • Hospitalist Physician
  • French Camp, CA
  • NPI 1104319771
  NPD
• Aladean Abdrabbo, M.D.

  • Internal Medicine Physician
  • Orange, CA
  • NPI 1578905675
  NPD
• Wajidah Abdul-Khabir

  • Hospitalist Physician
  • Duarte, CA
  • NPI 1215323522
  NPD
• Gloria Beth Abels, MD

  • Internal Medicine Physician
  • Eureka, CA
  • NPI 1235236662
  NPD
• Katharina Abernethy, PA, PTA

  • Physician Assistant
  • Windsor, CA
  • NPI 1518039536
  NPD
• Nicholas Michael Abraham, M.D.

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1770984098
  NPD
• Alexandra Abrew, PA-C

  • Physician Assistant
  • Fullerton, CA
  • NPI 1750031647
  NPD
• Leila Abuhadba

  • Physician Assistant
  • Fullerton, CA
  • NPI 1831876119
  NPD
• Gregory T. Ackroyd, M.D.

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Santa Rosa, CA
  • NPI 1538192984
  NPD
• Kimberlee Adams, NP

  • Nurse Practitioner
  • Eureka, CA
  • NPI 1386403020
  NPD

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": "",
            "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"
        }
    ]
}

• Makayla Provencher
• Maria Renee Provencio
• Michael S. Provenghi, MD
• Provide Homecare Inc
• Providence Medical Foundation
• Jennifer Pruce
• Jennifer Denise Prudencio
• Prudent Healthcare Services Nursing
• Thavarat Pruitt
• Jawni Prunchak

• Family Medicine Physician in Anaheim, CA
• Providers in Anaheim, CA by specialty
• Family Medicine Physician in California

• 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.