Poom Medical Clinic Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A 70122 Issued in CA

Legal business name

POOM MEDICAL CLINIC INC

Practice address

2055 N Perris Blvd Ste E6
Perris, CA 92571-2517

Phone

(951) 940-4176

Fax

(951) 940-4038

NPI assigned

Jun 8, 2016

Organization subpart

No

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

Authorized official

Name

Lida Poommipanit-Bajon, MDNPI 1861563413

Title

Secretary

Phone

(808) 419-1187

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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

• Lida Bee Poommipanit-Bajon, MD

  • Family Medicine Physician
  • Perris, CA
  • NPI 1861563413
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1465344000000",
    "number": "1831548197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16293 REGENCY RANCH RD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925045654",
            "telephone_number": "808-419-1187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 N PERRIS BLVD STE E6",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925712517",
            "telephone_number": "951-940-4176",
            "fax_number": "951-940-4038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POOM MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-08",
        "last_updated": "2016-06-08",
        "status": "A",
        "authorized_official_last_name": "POOMMIPANIT-BAJON",
        "authorized_official_first_name": "LIDA",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "808-419-1187",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A 70122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kakesha Phillips
• Pico de Loro, Incorporated
• Guillermo Pina, AMFT140631
• Trena Renee Pleasant, RN
• Nicole Lynn Plonte
• Lida Bee Poommipanit-Bajon, MD
• Patricia Ann Pope
• Rosie Pope
• Tyoni Pough-Bryant
• Precious Arrivals Doula Services

• Family Medicine Physician in Perris, CA
• Providers in Perris, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.