NPIMap

Organization Active NPI

San Luis Rey Medical Group

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Temecula, CA
National Provider Identifier
1689117137
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
SAN LUIS REY MEDICAL GROUP
Practice address
27710 Jefferson Ave Ste 207
Temecula, CA 92590-4604
Phone
(833) 668-6676
Fax
(866) 299-8639
NPI assigned
Nov 30, 2016
Last updated
Jul 19, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Authorized official

Name
Angela Mouton
Title
Sr VP Operations
Phone
(949) 240-7200

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X NU
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X NU Primary

Addresses

Primary practice location

27710 Jefferson Ave Ste 207
Temecula, CA 92590-4604

Mailing address

6400 Oak Cyn
Suite 200
Irvine, CA 92618-5203
Phone (858) 229-6156

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161227000449 CA Part B Supplier - Clinic/Group Practice 4284915612 Receives reassigned benefits from 10 practitioners
Practice locations: Temecula, CA

National Provider Directory

National Provider Directory

Locations

27710 Jefferson Ave
Ste 207
Temecula, CA 92590
Phone (833) 668-6676

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1689117137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 OAK CYN",
            "address_2": "SUITE 200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926185203",
            "telephone_number": "858-229-6156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27710 JEFFERSON AVE STE 207",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925904604",
            "telephone_number": "833-668-6676",
            "fax_number": "866-299-8639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS REY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-30",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A",
        "authorized_official_last_name": "MOUTON",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "SR VP OPERATIONS",
        "authorized_official_telephone_number": "949-240-7200"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.