Organization Active NPI

Premier Emergency Physicians of California Medical Group PC

  • Emergency Medicine Physician
  • Blythe, CA
National Provider Identifier
1922058221
Registry record updated Apr 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC
Practice address
250 N 1St St
Emergency Department
Blythe, CA 92225-1702
Phone
(760) 922-4115
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2021

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

Authorized official

Name
Kathy Kondas
Title
Officer
Phone
(973) 251-1132

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

250 N 1St St
Emergency Department
Blythe, CA 92225-1702

Mailing address

815 S Palafox St
Ste 300
Pensacola, FL 32502-5960
Phone (800) 444-7009

Other identifiers 2

IdentifierTypeStateIssuer
ZZZ64207ZOtherCABLUE SHIELD OF CALIFORNIA
GR0094162MedicaidCA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617926400000",
    "number": "1922058221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 S PALAFOX ST",
            "address_2": "STE 300",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325025960",
            "telephone_number": "800-444-7009",
            "fax_number": "800-305-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 N 1ST ST",
            "address_2": "EMERGENCY DEPARTMENT",
            "city": "BLYTHE",
            "state": "CA",
            "postal_code": "922251702",
            "telephone_number": "760-922-4115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER EMERGENCY PHYSICIANS OF CALIFORNIA MEDICAL GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2021-04-09",
        "certification_date": "2021-04-09",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHY",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "973-251-1132"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ64207Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0094162",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blythe, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; 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.