NPIMap

Individual provider Active NPI

Warren Regh C. Gabrillo III, M.D.

  • Family Medicine Physician
  • Upland, CA
National Provider Identifier
1982689295
Registry record updated Dec 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A51794 Issued in CA
Practice address
631 N 13TH Ave
A
Upland, CA 91786-4946
Phone
(909) 982-2088
Fax
(909) 982-2058
NPI assigned
Dec 8, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A51794 CA Primary

Addresses

Primary practice location

631 N 13TH Ave
A
Upland, CA 91786-4946

Mailing address

631 N 13TH Ave
A
Upland, CA 91786-4946
Phone (909) 982-2088

Other identifiers 1

IdentifierTypeStateIssuer
A517941MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080130000388 CA Practitioner - Family Practice 2668437088 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

219 E Foothill Blvd
Pomona, CA 91767-1403
Phone (906) 593-1391

Hospital & facility affiliations

  • Nu Care Home Health Home health agency, Rancho Cucamonga, CA, CCN 757252
  • Serenity Hospice Care Hospice, Claremont, CA, CCN 051765
  • San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A51794CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Warren Regh C. Gabrillo III M.D. Inc. Family Medicine CurrentSince Dec 1, 2007 Accepting new patients
Cas Health Medical Group LLC Family Medicine Current Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients
THC - Orange County, LLC Past Accepting new patients
Primecare Medical Group Past Accepting new patients

Locations

219 E Foothill Blvd
Pomona, CA 91767
Phone (906) 593-1391

631 N 13th Ave
Ste A
Upland, CA 91786
Phone (909) 982-2088

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ICAABA/Endpoint/ICAABA

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Serenity Hospice CareClaremont, CA, CCN 051765 Hospice Contracted Managing Employee Sep 12, 2007

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355097600000",
    "number": "1982689295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 N 13TH AVE",
            "address_2": "A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864946",
            "telephone_number": "909-982-2088",
            "fax_number": "909-982-2058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 N 13TH AVE",
            "address_2": "A",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864946",
            "telephone_number": "909-982-2088",
            "fax_number": "909-982-2058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GABRILLO",
        "first_name": "WARREN REGH",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2012-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A51794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A517941",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Upland, CA

Sources for this page

Verify at the official NPI Registry.