Moreno Valley Medical Group, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MORENO VALLEY MEDICAL GROUP, INC

Practice address

24490 Sunnymead Blvd
Moreno Valley, CA 92553-7734

Phone

(951) 242-9595

NPI assigned

Mar 5, 2020

Organization subpart

No

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

Authorized official

Name

Mr. Jeffrey P Richards Sr., CMAIII

Title

Office Manager

Phone

(951) 242-9595

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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

• Nizar Isa Ibrahim, M.D.

  • Family Medicine Physician
  • Moreno Valley, CA
  • NPI 1740364926
  NPD (past)

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

{
    "created_epoch": "1583366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678147200000",
    "number": "1740815166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24490 SUNNYMEAD BLVD STE 117",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925537764",
            "telephone_number": "951-242-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24490 SUNNYMEAD BLVD",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925537734",
            "telephone_number": "951-242-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORENO VALLEY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-05",
        "last_updated": "2023-03-07",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "RICHARDS",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "951-242-9595",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "CMAIII"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A703100",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Moreno Valley Community Medical Group
• Moreno Valley Dental Center
• Moreno Valley Dialysis Center
• Moreno Valley Imaging, L.L.C.
• Moreno Valley Med Care LLC
• Moreno Valley Physicians Associates, a Medical Corp
• Moreno Valley Regional Dialysis
• Moreno Valley SL I Limited Partnership
• Moreno Valley SNF, LLC
• Moreno Valley Unified School District

• Family Medicine Physician in Moreno Valley, CA
• Providers in Moreno 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 Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.