Prime Access Medical Group

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

PRIME ACCESS MEDICAL GROUP

Practice address

12611 9TH St
Chino, CA 91710-3528

Phone

(626) 657-8002

Fax

(626) 270-4328

NPI assigned

Sep 20, 2024

Organization subpart

No

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

Authorized official

Name

Gabrielle Gonzalez

Title

Credentialing Specialist

Phone

(909) 684-4404

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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.

• Victor Shi, M.D.

  • Vascular & Interventional Radiology Physician
  • Montebello, CA
  • NPI 1770857427
  Medicare reassignment NPD
• David Song

  • Urology Physician
  • Chino, CA
  • NPI 1699115972
  Medicare reassignment NPD

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1912724048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W GARVEY AVE STE 102-502",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917547418",
            "telephone_number": "626-657-8002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12611 9TH ST",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103528",
            "telephone_number": "626-657-8002",
            "fax_number": "626-270-4328"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1417 W Beverly Blvd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Montebello",
            "state": "CA",
            "postal_code": "906404125",
            "country_code": "US",
            "telephone_number": "626-657-8002",
            "fax_number": "626-270-4328",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PRIME ACCESS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-19",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "GABRIELLE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "909-684-4404"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachael Juliette Ponce
• Ponte Nutrition Care PC
• Oksana Pradun, FNP
• Premier Platinum Transportation LLC
• Gabriel Prieto
• Primecare Medical Group of Chino Valley
• Professional Medical Care
• Professional Nurses Group, Inc. (Aloha Healthcare)
• Professional Nurses Group, Inc. (Aloha Healthcare)
• Prohealth Logistics

• Vascular & Interventional Radiology Physician in Chino, CA
• Providers in Chino, CA by specialty
• Vascular & Interventional Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; 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.