Pioneer Medical Group, Inc.

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

A42053 Issued in CA

Legal business name

PIONEER MEDICAL GROUP, INC.

Practice address

16510 Bloomfield Ave
Cerritos, CA 90703-2115

Phone

(562) 229-0902

NPI assigned

Mar 23, 2007

Reactivated

Feb 16, 2012

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Pioneer Medical Group2 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pionerr Medical Group Inc

  • Multi-Specialty Clinic/Center
  • Cerritos, CA
  • NPI 1912929852
  NPD tax ID

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350864000000",
    "number": "1932226941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16510 BLOOMFIELD AVE",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907032115",
            "telephone_number": "562-229-0902"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PIONEER MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-03-23",
        "last_updated": "2012-10-22",
        "deactivation_date": "2012-01-23",
        "reactivation_date": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A42053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adriana Julia Pineda
• Carlos Augusto Pineda
• Katherine Pineda, APCC
• Maria Pineda
• Sandra Lee Pinkney
• Pionerr Medical Group Inc
• Sheldon Pitluk, O.D.
• Sarah Pittman
• Platinum Global Diagnostic
• Stephanie Lee Platt, MSW

• Non-Pharmacy Dispensing Site in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.