Formula Medical Group a Professional Medical Corporation

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G48897 Issued in CA

Legal business name

FORMULA MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION

Practice address

18182 US Highway 18
Suite 105
Apple Valley, CA 92307-2200

Phone

(760) 242-1234

Fax

(760) 242-5527

NPI assigned

Jul 18, 2006

Organization subpart

No

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

Authorized official

Name

James Krider, M.DNPI 1215959945

Title

Doctor

Phone

(760) 242-1234

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

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

• James Krider, M.D

  • Family Medicine Physician
  • Apple Valley, CA
  • NPI 1215959945
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589414400000",
    "number": "1710905690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18182 US HIGHWAY 18",
            "address_2": "SUITE 105",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072200",
            "telephone_number": "760-242-1234",
            "fax_number": "760-242-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18182 US HIGHWAY 18",
            "address_2": "SUITE 105",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "923072200",
            "telephone_number": "760-242-1234",
            "fax_number": "760-242-5527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORMULA MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2020-05-14",
        "certification_date": "2020-05-14",
        "status": "A",
        "authorized_official_last_name": "KRIDER",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "760-242-1234",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G48897",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Follis
• Jacqueline Yesenia Fonville
• Stacy S. Forcino, PH.D.
• Matthew D Ford
• Tenisha Dianne Ford
• Shawna Marie Foronda
• Mickie Elena Forsberg, NP
• James Jay Fowlie, DDS
• Lisa K Frandsen
• Renee Frank, CRT,RCP

• Family Medicine Physician in Apple Valley, CA
• Providers in Apple Valley, 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 May 14, 2020; 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.