NPIMap

Desert Valley Medical Group, Inc.

Organization Active NPI Preventive Medicine/Occupational Environmental Medicine Physician · Victorville, CA

NPI 1912945114 · NPPES record last updated Apr 27, 2020

Key facts

NPI
1912945114
Entity type
Organization (NPI type 2)
Primary specialty
Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X
Legal business name
DESERT VALLEY MEDICAL GROUP, INC.
Practice address
12401 Hesperia Rd
Victorville, CA 92395-7707
Phone
(760) 241-8000
NPI assigned
Jun 2, 2006
Organization subpart
No

Authorized official

Name
Dr. Kavitha Bhatia, M.D.
Title
President/Owner
Phone
(760) 241-8000

Other NPIs on the same Medicare enrollment 11

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

Practitioners 4

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

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

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD
    Plans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Preventive Medicine/Occupational Environmental Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2083P0500X Yes

Addresses

Primary practice location

12401 Hesperia Rd
Victorville, CA 92395-7707

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
4584430004OtherCADMERC
GR0072098MedicaidCA

Other names

  • Primecare Medical Group of Desert Valley, Inc. Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 27, 2020.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587945600000",
    "number": "1912945114",
    "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": "12401 HESPERIA RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923957707",
            "telephone_number": "760-241-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESERT VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "BHATIA",
        "authorized_official_first_name": "KAVITHA",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "760-241-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2083P0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4584430004",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0072098",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Primecare Medical Group of Desert Valley, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Primecare Medical Group of Desert Valley, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Victorville, CA

All providers in Victorville, CA · Preventive Medicine/Occupational Environmental Medicine Physician in California

Sources for this page

Verify at the official NPI Registry.