Active NPI
Molina Healthcare of California
- Family Medicine Physician
- Pomona, CA
National Provider Identifier
1932214228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- MOLINA HEALTHCARE OF CALIFORNIA
- Practice address
- 887 E Second St
Pomona, CA 91766-2009 - Phone
- (909) 620-7769
- Fax
- (877) 778-6944
- NPI assigned
- Aug 20, 2006
- Last updated
- Dec 6, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Matthew Schueren
- Title
- V.P. Finance
- Phone
- (888) 562-5442
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | CA | Primary | |
| Internal Medicine Physician | 207R00000X |
Addresses
Primary practice location
887 E Second St
Pomona, CA 91766-2009
Mailing address
200 Oceangate
#100
Long Beach, CA 90802-4317
Phone (562) 499-6191
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0042656 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061101000348 | CA | Part B Supplier - Clinic/Group Practice | 7517957608 |
Receives reassigned benefits from 343 practitioners 10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Long Beach, CA |
Other NPIs on the same Medicare enrollment 7
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Medicine Physician
- Long Beach, CA
- NPI 1184738569
O20061101000348
-
dba Molina Medical Centers
- Health Maintenance Organization
- Long Beach, CA
- NPI 1194811760
O20061101000348
-
- Family Medicine Physician
- Wilmington, CA
- NPI 1497869887
O20061101000348
-
dba Molina Medical Centers
- Family Medicine Physician
- Lancaster, CA
- NPI 1508970955
O20061101000348
-
- Family Medicine Physician
- Long Beach, CA
- NPI 1669586020
O20061101000348
-
- Family Medicine Physician
- Riverside, CA
- NPI 1750663191
O20061101000348
-
- Family Medicine Physician
- San Bernardino, CA
- NPI 1861507006
O20061101000348
National Provider Directory
National Provider DirectoryLocations
887 E 2nd St
Pomona, CA 91766
Phone (909) 620-7769
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1512518400000",
"number": "1932214228",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 OCEANGATE",
"address_2": "#100",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908024317",
"telephone_number": "562-499-6191",
"fax_number": "562-499-6171"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "887 E SECOND ST",
"city": "POMONA",
"state": "CA",
"postal_code": "917662009",
"telephone_number": "909-620-7769",
"fax_number": "877-778-6944"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOLINA HEALTHCARE OF CALIFORNIA",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-20",
"last_updated": "2017-12-06",
"status": "A",
"authorized_official_last_name": "SCHUEREN",
"authorized_official_first_name": "MATTHEW",
"authorized_official_title_or_position": "V.P. FINANCE",
"authorized_official_telephone_number": "888-562-5442"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0042656",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2017; 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.