NPIMap

Organization Active NPI

Riverside Psychiatric Medical Group

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Riverside, CA
National Provider Identifier
1972691228
Registry record updated Dec 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
RIVERSIDE PSYCHIATRIC MEDICAL GROUP
Practice address
5887 Brockton Ave
Ste a Riverside Psychiatric Medical Group
Riverside, CA 92506
Phone
(951) 275-8500
Fax
(951) 275-8560
NPI assigned
Oct 11, 2006
Last updated
Dec 20, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2013

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

Authorized official

Name
Mr. Robert B. Summerour, MDNPI 1811085160
Title
Owner
Phone
(951) 275-8500

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
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

5887 Brockton Ave
Ste a Riverside Psychiatric Medical Group
Riverside, CA 92506

Mailing address

5887 Brockton Ave
Ste a Riverside Psychiatric Medical Group
Riverside, CA 92506
Phone (951) 275-8500

Other names 1

  • Riverside Psych Med Group Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031222000671 CA Part B Supplier - Clinic/Group Practice 8426956954 Receives reassigned benefits from 12 practitioners
Practice locations: Riverside, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2162307Riverside Psychiatric Medical Group5887 Brockton Avenue, Suite a, Riverside, CA 92506Certificate of waiverFeb 19, 2027

National Provider Directory

National Provider Directory

Locations

5887 Brockton Ave
Riverside, CA 92506
Phone (951) 275-8500

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387497600000",
    "number": "1972691228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5887 BROCKTON AVE",
            "address_2": "STE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92506",
            "telephone_number": "951-275-8500",
            "fax_number": "951-275-8560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5887 BROCKTON AVE",
            "address_2": "STE A RIVERSIDE PSYCHIATRIC MEDICAL GROUP",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "92506",
            "telephone_number": "951-275-8500",
            "fax_number": "951-275-8560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE PSYCHIATRIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-11",
        "last_updated": "2013-12-20",
        "status": "A",
        "authorized_official_last_name": "SUMMEROUR",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-275-8500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Psych Med Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.