NPIMap

Organization Active NPI

Redlands Family Practice Medical Group Inc.

Doing business as Optum

  • Family Medicine Physician
  • Redlands, CA
National Provider Identifier
1942482021
Registry record updated Jul 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
REDLANDS FAMILY PRACTICE MEDICAL GROUP INC.
Doing business as
Optum
Practice address
1520 Barton Rd
Redlands, CA 92373-5467
Phone
(909) 793-3208
NPI assigned
Nov 30, 2007
Last updated
Jul 28, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
REDLANDS FAMILY PRACTICE MEDICAL GROUP INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 28, 2022

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

Authorized official

Name
Ashley Grim
Title
Practice Administrator
Phone
(909) 793-3208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

1520 Barton Rd
Redlands, CA 92373-5467

Mailing address

1520 Barton Rd
Redlands, CA 92373-5467
Phone (909) 793-3208

Other names 1

  • Optum Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150707001603 CA Part B Supplier - Clinic/Group Practice 7214249127 Receives reassigned benefits from 29 practitioners
Practice locations: Fontana, CA; Redlands, CA; San Bernardino, CA

National Provider Directory

National Provider Directory
Part of
Redlands Family Practice Medical Group Inc

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658966400000",
    "number": "1942482021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1520 BARTON RD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735467",
            "telephone_number": "909-793-3208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 BARTON RD",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923735467",
            "telephone_number": "909-793-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REDLANDS FAMILY PRACTICE MEDICAL GROUP INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REDLANDS FAMILY PRACTICE MEDICAL GROUP INC",
        "enumeration_date": "2007-11-30",
        "last_updated": "2022-07-28",
        "certification_date": "2022-07-28",
        "status": "A",
        "authorized_official_last_name": "GRIM",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "909-793-3208"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optum",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2022; 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.