Primary Care Family Practice Apc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

C53604 Issued in CA

Legal business name

PRIMARY CARE FAMILY PRACTICE APC

Practice address

6900 Brockton Ave Ste 200
Riverside, CA 92506-3818

Phone

(951) 682-6263

NPI assigned

Feb 13, 2017

Organization subpart

No

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

Authorized official

Name

Samer Sannoufi, MD

Title

Owner

Phone

(951) 682-6263

Specialties & licenses 2

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1486944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1851830699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 BROCKTON AVE STE 200",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925063818",
            "telephone_number": "951-682-6263"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "28300 Hwy 189",
            "address_2": "Suite 02-220/4",
            "address_purpose": "LOCATION",
            "city": "Lake Arrowhead",
            "state": "CA",
            "postal_code": "923529235",
            "country_code": "US",
            "telephone_number": "714-398-5246",
            "fax_number": "951-682-0114",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 Magnolia Ave Ste 109",
            "address_purpose": "LOCATION",
            "city": "Corona",
            "state": "CA",
            "postal_code": "928793123",
            "country_code": "US",
            "telephone_number": "951-682-6263",
            "fax_number": "951-682-0114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIMARY CARE FAMILY PRACTICE APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-13",
        "last_updated": "2020-11-13",
        "certification_date": "2020-11-12",
        "status": "A",
        "authorized_official_last_name": "SANNOUFI",
        "authorized_official_first_name": "SAMER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-682-6263",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C53604",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Riverside",
            "affiliation": "N",
            "endpointDescription": "Server",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "6900 Brockton Ave Ste 200",
            "city": "Riverside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "925063818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Providers in Riverside, CA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2020; 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.