NPIMap

Organization Active NPI

Riverside Family Physicians, a Professional Medical Corporation

  • Family Medicine Physician
  • Riverside, CA
National Provider Identifier
1790713394
Registry record updated Oct 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RIVERSIDE FAMILY PHYSICIANS, A PROFESSIONAL MEDICAL CORPORATION
Practice address
4310 Orange St
Riverside, CA 92501-3829
Phone
(951) 781-6335
Fax
(951) 781-6365
NPI assigned
Jun 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2012

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

Authorized official

Name
Dr. Tarek Zaki Mahdi, M.D.NPI 1932137544
Title
President/Physicician
Phone
(951) 781-6335

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4310 Orange St
Riverside, CA 92501-3829

Mailing address

4310 Orange St
Riverside, CA 92501-3829
Phone (951) 781-6335

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040922000919 CA Part B Supplier - Clinic/Group Practice 4587632005 Receives reassigned benefits from 8 practitioners
Practice locations: Riverside, CA

National Provider Directory

National Provider Directory

Locations

161 N McKinley St
Corona, CA 92879
Phone (909) 272-4812

3400 Central Ave
Ste 235
Riverside, CA 92506

4244 Riverwalk Pkwy
Ste 150
Riverside, CA 92505
Phone (951) 335-4660

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349827200000",
    "number": "1790713394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4310 ORANGE ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013829",
            "telephone_number": "951-781-6335",
            "fax_number": "951-781-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 ORANGE ST",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925013829",
            "telephone_number": "951-781-6335",
            "fax_number": "951-781-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE FAMILY PHYSICIANS, A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-30",
        "last_updated": "2012-10-10",
        "status": "A",
        "authorized_official_last_name": "MAHDI",
        "authorized_official_first_name": "TAREK",
        "authorized_official_middle_name": "ZAKI",
        "authorized_official_title_or_position": "PRESIDENT/PHYSICICIAN",
        "authorized_official_telephone_number": "951-781-6335",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "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 Oct 10, 2012; 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.