Southern California Permanente Medical Group
Organization Active NPI Health Maintenance Organization · Fontana, CA
NPI 1689606196 · NPPES record last updated Nov 2, 2021
Key facts
- NPI
- 1689606196
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Maintenance Organization 302R00000X
- Legal business name
- SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
- Practice address
- 9961 Sierra Ave
Fontana, CA 92335-6720 - Phone
- (909) 427-3910
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Ramin Davidoff, MD
- Title
- Executive Medical Director
- Phone
- (877) 608-0044
Other NPIs on the same Medicare enrollment 17
Practitioners 2,078
-
Mekabiz Abaian, MD
-
Danish Abbas, M.D.
-
Angela Lynn Abbott, LMFT
-
Solomon O. Abila, MD
-
Jenny Ahmed Abouelsood, M.D.
-
Marla L. Abrolat, MD
-
Hana Nazih Abuershaid, M.D.
-
Daniel C Acevedo, M.D.
-
Olga Acosta, MD
-
Nichole Marie Adair, D.O.
-
Yarameekah Adams, MD
-
Sheila Marie Adaya Adan, D.O.
-
Camille Adeimy, MD
-
Meron Admassu, RN
-
Arman Afagh, MD
-
Payam Afshar, M.D.
-
Janice D Agdigos, LMFT
-
Tara Rithaporn Agena, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040126000823 | CA | Part B Supplier - Clinic/Group Practice | 6002729175 |
Receives reassigned benefits from 5,496 practitioners 7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
| O20260217001864 | CA | MDPP Supplier - in-Person MDPP Supplier With Distance Learning | 6002729175 |
12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
3750 Grand Ave
Chino, CA 91710
Phone (909) 902-2929
789 E Cooley Dr
Colton, CA 92324
Phone (909) 370-6001
9310 Sierra Ave
Fontana, CA 92335
Phone (909) 427-3700
14135 Main St
Hesperia, CA 92345
Phone (760) 947-7405
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | Yes |
Addresses
Primary practice location
9961 Sierra Ave
Fontana, CA 92335-6720
Mailing address
393 E Walnut St
3Rd FL PHR Group & Provider Enrollment
Pasadena, CA 91188-0001
Phone (626) 405-7914
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ41545Z | Medicaid | CA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) |
Other providers in Fontana, CA
- Heaven L Soto
- Jasmin A Soto
- South Pacific Rehabilitation Services
- Southern California Permanente Medical Group
- Southern California Permanente Medical Group
- Southern California Picc Providers, Inc.
- Southridge Dental Group
- Lisa Lam Sparks
- Robert Speaks
- Rebecca Spence Dobias
All providers in Fontana, CA · Health Maintenance Organization in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.