NPIMap

Individual provider Active NPI

Joel A Pengson, MD

  • Internal Medicine Physician
  • Moreno Valley, CA
National Provider Identifier
1720018237
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G72774 Issued in CA
Practice address
23180 Hemlock Ave Ste 201
Moreno Valley, CA 92557-8001
Phone
(951) 243-6460
Fax
(951) 243-5871
NPI assigned
Jul 3, 2006
Last updated
Dec 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 13, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G72774 CA Primary

Addresses

Primary practice location

23180 Hemlock Ave Ste 201
Moreno Valley, CA 92557-8001

Mailing address

30907 Riverton LN
Temecula, CA 92591-7033
Phone (951) 526-2722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041204000223 CA Practitioner - Internal Medicine 9638135353 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
R Franklin University of Med & Sci/Chicago Medical School, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Moreno Valley Community Medical GroupGroup PAC ID 8224316203, 3 clinicians

Practice addresses (Care Compare)

23180 Hemlock Ave
Suite 201
Moreno Valley, CA 92557-8001
Phone (951) 243-6460

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.21 of 100Reported as individual
Quality
83.82
Promoting interoperability
97
Improvement activities
40
Cost
59.39

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G72774CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Moreno Valley CMHC CurrentSince Sep 1, 2021 Accepting new patients
Riverside Healthcare System, L.P. Past Accepting new patients
Doctors Hospital of Riverside LLC Past Accepting new patients
Uhs Corona Inc Past Accepting new patients
GN Medical Associates, Inc. PastSince Apr 1, 2007 Accepting new patients
Mowbray P. Hagan, M.D. Inc. Past Accepting new patients
Deo Martinez MD PC Internal Medicine Past Accepting new patients

Locations

23180 Hemlock Ave
Moreno Valley, CA 92557
Phone (951) 243-6460

23180 Hemlock Ave
Ste 100
Moreno Valley, CA 92557
Phone (951) 266-9880

23180 Hemlock Ave
Ste 201
Moreno Valley, CA 92557
Phone (909) 204-7860

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: joel.pengson.1@27911.direct.athenahealth.com
  • Direct secure messaging: joel.pengson.2@28408.direct.athenahealth.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576195200000",
    "number": "1720018237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30907 RIVERTON LN",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925917033",
            "telephone_number": "951-526-2722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23180 HEMLOCK AVE STE 201",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925578001",
            "telephone_number": "951-243-6460",
            "fax_number": "951-243-5871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENGSON",
        "first_name": "JOEL",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G72774",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moreno Valley, CA

Sources for this page

Verify at the official NPI Registry.