NPIMap

Organization Active NPI

Chaparral Medical Group Inc.

  • Cardiovascular Disease Physician
  • Upland, CA
National Provider Identifier
1831442078
Registry record updated Oct 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
CHAPARRAL MEDICAL GROUP INC.
Practice address
591 N 13TH Ave
Suite 3
Upland, CA 91786-4967
Phone
(909) 985-5885
Fax
(909) 920-3379
NPI assigned
Oct 25, 2012
Last updated
Oct 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2012

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

Authorized official

Name
Adrienne Walker
Title
Contracts Manager
Phone
(909) 398-1500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Cardiovascular Disease Physician 207RC0000X NU Primary

Addresses

Primary practice location

591 N 13TH Ave
Suite 3
Upland, CA 91786-4967

Mailing address

840 Towne Center Dr
Pomona, CA 91767-5900
Phone (909) 398-1550

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040331001684 CA Part B Supplier - Clinic/Group Practice 6800709403 Receives reassigned benefits from 114 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rancho Cucamonga, CA; San Bernardino, CA; San Francisco, CA; Upland, CA; Chino, CA; Chino Hills, CA; Bakersfield, CA

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Venkata Pulakanti MD34 organizations share this tax ID, including this one

Other organizations with this tax ID 33

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

View all 33

Locations

9190 Haven Ave
Ste 101
Rancho Cucamonga, CA 91730
Phone (909) 581-6732

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1351123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1831442078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 TOWNE CENTER DR",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675900",
            "telephone_number": "909-398-1550",
            "fax_number": "909-398-1573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 N 13TH AVE",
            "address_2": "SUITE 3",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864967",
            "telephone_number": "909-985-5885",
            "fax_number": "909-920-3379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHAPARRAL MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-25",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "ADRIENNE",
        "authorized_official_title_or_position": "CONTRACTS MANAGER",
        "authorized_official_telephone_number": "909-398-1500"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.