NPIMap

Organization Active NPI

Kaiser Foundation Health Plan Inc

  • Community/Retail Pharmacy
  • Fontana, CA
National Provider Identifier
1821146457
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY39805 Issued in CA
Legal business name
KAISER FOUNDATION HEALTH PLAN INC
Practice address
9985 Sierra Ave FL 2
BLDG 1
Fontana, CA 92335-6720
Phone
(866) 340-6109
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Authorized official

Name
Rhonda Lee Polchak
Title
VP Pharmacy Operations & SVCS, Scal
Phone
(562) 658-3510

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY39805 CA Primary

Addresses

Primary practice location

9985 Sierra Ave FL 2
BLDG 1
Fontana, CA 92335-6720

Mailing address

12254 Bellflower Blvd FL 2
Pharmacy Operations Department
Downey, CA 90242-2804

Other identifiers 2

IdentifierTypeStateIssuer
0567620OtherNCPDP PROVIDER IDENTIFICATION NUMBER
1821146457MedicaidCA

Other names 1

  • KAISER PERMANENTE PHARMACY #197 Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE)

National Provider Directory

National Provider Directory
Tax ID family
Kaiser FDN HLTH Plan Phcy379 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

9985 Sierra Ave
Fl 2
Fontana, CA 92335
Phone (909) 427-4783

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1821146457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12254 BELLFLOWER BLVD FL 2",
            "address_2": "PHARMACY OPERATIONS DEPARTMENT",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "902422804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9985 SIERRA AVE FL 2",
            "address_2": "BLDG 1",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923356720",
            "telephone_number": "866-340-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HEALTH PLAN INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A",
        "authorized_official_last_name": "POLCHAK",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "VP PHARMACY OPERATIONS & SVCS, SCAL",
        "authorized_official_telephone_number": "562-658-3510"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY39805",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "0567620",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821146457",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9985 Sierra Ave Fl 2",
            "address_2": "Bldg 1",
            "city": "Fontana",
            "state": "CA",
            "country_code": "US",
            "postal_code": "923356720",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "KAISER PERMANENTE PHARMACY #197",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fontana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 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.