NPIMap

Organization Active NPI

Ultimate Medical Practice a Professional Corporation

  • Primary Care Clinic/Center
  • Highland, CA
National Provider Identifier
1962659573
Registry record updated Mar 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A55122 Issued in CA
Legal business name
ULTIMATE MEDICAL PRACTICE A PROFESSIONAL CORPORATION
Practice address
3654 Highland Ave
Suite 15
Highland, CA 92346-2614
Phone
(909) 864-1006
Fax
(909) 864-1625
NPI assigned
Aug 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2009

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

Authorized official

Name
Dr. Richard KangahNPI 1255379681
Title
Medical Director/President
Phone
(909) 864-1006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A55122 CA Primary

Addresses

Primary practice location

3654 Highland Ave
Suite 15
Highland, CA 92346-2614

Mailing address

3654 Highland Ave
Suite 15
Highland, CA 92346-2614
Phone (909) 864-1006

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090112000131 CA Part B Supplier - Clinic/Group Practice 0244393619 Receives reassigned benefits from 2 practitioners
Practice locations: Highland, CA

National Provider Directory

National Provider Directory

Locations

3654 Highland Ave
Ste 15
Highland, CA 92346
Phone (909) 864-1006

3606 Highland Ave
Ste 108
Highland, CA 92346
Phone (909) 864-1006

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/15368/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236124800000",
    "number": "1962659573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3654 HIGHLAND AVE",
            "address_2": "SUITE 15",
            "city": "HIGHLAND",
            "state": "CA",
            "postal_code": "923462614",
            "telephone_number": "909-864-1006",
            "fax_number": "909-864-1625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3654 HIGHLAND AVE",
            "address_2": "SUITE 15",
            "city": "HIGHLAND",
            "state": "CA",
            "postal_code": "923462614",
            "telephone_number": "909-864-1006",
            "fax_number": "909-864-1625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMATE MEDICAL PRACTICE A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-26",
        "last_updated": "2009-03-04",
        "status": "A",
        "authorized_official_last_name": "KANGAH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/PRESIDENT",
        "authorized_official_telephone_number": "909-864-1006",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A55122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2009; 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.