NPIMap

Organization Active NPI

Desert Valley Medical Group, Inc.

  • Family Medicine Physician
  • Victorville, CA
National Provider Identifier
1841804101
Registry record updated Apr 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DESERT VALLEY MEDICAL GROUP, INC.
Doing business as
Desert Valley Medical Group, Inc.
Practice address
11883 Amethyst Rd Ste 203
Victorville, CA 92392-9224
Phone
(760) 241-8000
NPI assigned
Sep 3, 2020
Last updated
Apr 21, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2021

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

Authorized official

Name
Marie Langley
Title
Ipa Administrator
Phone
(760) 900-2155

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

11883 Amethyst Rd Ste 203
Victorville, CA 92392-9224

Mailing address

16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone (760) 241-8000

Other names 1

  • DESERT VALLEY MEDICAL GROUP, INC. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040113000803 CA Part B Supplier - Clinic/Group Practice 4880595875 Receives reassigned benefits from 151 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Victorville, CA; Hesperia, CA; Chino, CA; Apple Valley, CA

Other NPIs on the same Medicare enrollment 11

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2223644Desert Valley Medical Group, Inc11883 Amethyst Rd, Victorville, CA 92392Certificate of waiverMay 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Primecare of Desert Val7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

11883 Amethyst Rd
Ste 202
Victorville, CA 92392

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618963200000",
    "number": "1841804101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16850 BEAR VALLEY RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955794",
            "telephone_number": "760-241-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11883 AMETHYST RD STE 203",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923929224",
            "telephone_number": "760-241-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-03",
        "last_updated": "2021-04-21",
        "certification_date": "2021-04-21",
        "status": "A",
        "authorized_official_last_name": "LANGLEY",
        "authorized_official_first_name": "MARIE",
        "authorized_official_title_or_position": "IPA ADMINISTRATOR",
        "authorized_official_telephone_number": "760-900-2155"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DESERT VALLEY MEDICAL GROUP, INC.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DESERT VALLEY MEDICAL GROUP, INC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Victorville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; 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.