NPIMap

Organization Active NPI

Urology Center of So Calif Medical Group Inc

  • Urology Physician
  • Murrieta, CA
National Provider Identifier
1750604948
Registry record updated Aug 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
UROLOGY CENTER OF SO CALIF MEDICAL GROUP INC
Practice address
28078 Baxter Rd
#314
Murrieta, CA 92563-1402
Phone
(951) 677-3000
NPI assigned
Mar 2, 2010
Last updated
Aug 23, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2013

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

Authorized official

Name
Bruce Houman
Title
Ceo
Phone
(951) 735-2700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X CA Primary

Addresses

Primary practice location

28078 Baxter Rd
#314
Murrieta, CA 92563-1402

Mailing address

1820 Fullerton Ave
#260
Corona, CA 92881-3160

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315001245 CA Part B Supplier - Clinic/Group Practice 6406745439 Receives reassigned benefits from 16 practitioners
2 other NPIs on this enrollment
Practice locations: Riverside, CA; Murrieta, CA; Encinitas, CA; Corona, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Urology Center of So Calif Medical Group Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377216000000",
    "number": "1750604948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 FULLERTON AVE",
            "address_2": "#260",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928813160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28078 BAXTER RD",
            "address_2": "#314",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925631402",
            "telephone_number": "951-677-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY CENTER OF SO CALIF MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-02",
        "last_updated": "2013-08-23",
        "status": "A",
        "authorized_official_last_name": "HOUMAN",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-735-2700"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murrieta, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2013; 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.