NPIMap

Organization Active NPI

Inland Psychiatric Medical Group, Inc

  • Psychiatry Physician
  • Chino, CA
National Provider Identifier
1770905663
Registry record updated Nov 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
INLAND PSYCHIATRIC MEDICAL GROUP, INC
Practice address
12555 Central Ave Ste C
Chino, CA 91710-3569
Phone
(909) 902-1082
NPI assigned
Jan 10, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2018

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

Authorized official

Name
Gloria Arzate
Title
Credentialing
Phone
(909) 289-4075

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

12555 Central Ave Ste C
Chino, CA 91710-3569

Mailing address

1809 W Redlands Blvd
Redlands, CA 92373-8054

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000736 CA Part B Supplier - Clinic/Group Practice 9436062312 Receives reassigned benefits from 192 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Moreno Valley, CA; Palm Desert, CA; Rancho Cucamonga, CA; Hemet, CA; Redlands, CA; Riverside, CA; San Bernardino, CA; San Juan Capistrano, CA…

Other NPIs on the same Medicare enrollment 26

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

View all 26

National Provider Directory

National Provider Directory
Tax ID family
Inland Psychiatric Medical Group Inc39 organizations share this tax ID, including this one

Other organizations with this tax ID 38

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

View all 38

Locations

540 W Baseline Rd
Ste 3
Claremont, CA 91711
Phone (909) 542-0633

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1389312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543536000000",
    "number": "1770905663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1809 W REDLANDS BLVD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923738054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12555 CENTRAL AVE STE C",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103569",
            "telephone_number": "909-902-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INLAND PSYCHIATRIC MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-10",
        "last_updated": "2018-11-30",
        "status": "A",
        "authorized_official_last_name": "ARZATE",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "909-289-4075"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; 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.