Organization Active NPI

Molina Healthcare of California

  • Family Medicine Physician
  • Riverside, CA
National Provider Identifier
1750663191
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MOLINA HEALTHCARE OF CALIFORNIA
Practice address
5549 Van Buren Blvd
Riverside, CA 92503-2068
Phone
(951) 324-5901
Fax
(877) 778-9472
NPI assigned
Sep 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2017

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

Authorized official

Name
Matthew Schueren
Title
V.P. Finance
Phone
(888) 562-5442

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

5549 Van Buren Blvd
Riverside, CA 92503-2068

Mailing address

200 Oceangate
Suite 100
Long Beach, CA 90802-4317
Phone (562) 499-6191

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061101000348 CA Part B Supplier - Clinic/Group Practice 7517957608 Receives reassigned benefits from 343 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Long Beach, CA

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1315785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512518400000",
    "number": "1750663191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OCEANGATE",
            "address_2": "SUITE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024317",
            "telephone_number": "562-499-6191",
            "fax_number": "562-499-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5549 VAN BUREN BLVD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925032068",
            "telephone_number": "951-324-5901",
            "fax_number": "877-778-9472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOLINA HEALTHCARE OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-12",
        "last_updated": "2017-12-06",
        "status": "A",
        "authorized_official_last_name": "SCHUEREN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "V.P. FINANCE",
        "authorized_official_telephone_number": "888-562-5442"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; 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.