Heacock Health Medical Group, Inc.

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

HEACOCK HEALTH MEDICAL GROUP, INC.

Practice address

24060 Fir Ave Ste a
Moreno Valley, CA 92553-2895

Phone

(951) 247-8005

Fax

(951) 247-8007

NPI assigned

Feb 14, 2019

Last updated

Apr 15, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Rafael PenunuriNPI 1831270362

Title

Medical Director

Phone

(951) 247-8005

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 11

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.

• Rafael Arturo Penunuri, M.D.

  • Internal Medicine Physician
  • Newport Beach, CA
  • NPI 1831270362
  Medicare reassignment Authorized official
• Harikrishna Ambati, MD

  • Family Medicine Physician
  • Chino, CA
  • NPI 1154998730
  Medicare reassignment NPD
• Sirvard Silvia Ayrapetyan

  • Physician Assistant
  • North Hollywood, CA
  • NPI 1811667637
  Medicare reassignment NPD
• Ailin Chao

  • Nurse Practitioner
  • Tustin, CA
  • NPI 1700770922
  Medicare reassignment NPD
• Patrick Fong

  • Physician Assistant
  • Colton, CA
  • NPI 1538442611
  Medicare reassignment NPD
• Maxwell Jen, MD

  • Emergency Medicine Physician
  • Tustin, CA
  • NPI 1154688810
  Medicare reassignment NPD
• Srisha Anil Jhangiani, PA-C

  • Physician Assistant
  • Carson, CA
  • NPI 1013789411
  Medicare reassignment NPD
• Jamie Jungwon Yoon, NURSE PRACTITIONER

  • Adult Health Nurse Practitioner
  • Los Angeles, CA
  • NPI 1093486953
  Medicare reassignment NPD
• Phillip Yousef, PA

  • Physician Assistant
  • Glen Oaks, NY
  • NPI 1679052534

  CA

  Medicare reassignment NPD
• Atessa Mikanik

  • Physician Assistant
  • San Diego, CA
  • NPI 1841825965
  NPD (past)
• Divine Oluwatosin Ojelade, NP

  • Family Nurse Practitioner
  • Moreno Valley, CA
  • NPI 1417704032
  NPD (past)

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1891251849",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24060 FIR AVE STE A",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925532895",
            "telephone_number": "951-247-8005",
            "fax_number": "951-247-8007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24060 FIR AVE STE A",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925532895",
            "telephone_number": "951-247-8005",
            "fax_number": "951-247-8007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEACOCK HEALTH MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-14",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "PENUNURI",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "951-247-8005",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760896336",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wadih Antony Hawat, D.O.
• Rebecca Marie Hawkey
• Terrie Hawthorne, MSW
• Ezabelle Hayek, DMD
• Megan Marie Haynes, MSN, BSN
• Heal and Renew Family Counseling Center, Professional Corporation
• Healing Path Family Therapy Professional Corporation
• Heart to Hearts Care
• Doris Heath, NP-C
• Heavens Angel Health Services

• Urgent Care Clinic/Center in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• Urgent Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2025; 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.