NPIMap

Organization Active NPI

Prime Healthcare Services - Montclair, LLC

Doing business as Montclair Hopsital Medical Center

  • General Acute Care Hospital
  • Montclair, CA
National Provider Identifier
1992721161
Registry record updated Jun 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
PRIME HEALTHCARE SERVICES - MONTCLAIR, LLC
Doing business as
Montclair Hopsital Medical Center
Practice address
5000 San Bernardino St
Montclair, CA 91763-2326
Phone
(909) 625-4111
NPI assigned
Jul 14, 2006
Last updated
Jun 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2017

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

Authorized official

Name
Mr. Christopher Doan
Title
Chief Complinance Counsel
Phone
(909) 235-4307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

5000 San Bernardino St
Montclair, CA 91763-2326

Mailing address

16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone (760) 241-8222

Other names 1

  • Montclair Hopsital Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060714000286 CA Part A Provider - Hospital 4385657386 Practice locations: Montclair, CA
O20161101002657 CA Part B Supplier - Clinic/Group Practice 4082992623 Receives reassigned benefits from 49 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Upland, CA; Victorville, CA; San Dimas, CA; San Bernardino, CA; Pomona, CA; Banning, CA; Loma Linda, CA; Riverside, CA…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992721161. Details of each certification follow.

Hospital certification: CCN 050758

Legal name
PRIME HEALTHCARE SERVICES - MONTCLAIR LLC
Doing business as
MONTCLAIR HOSPITAL MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Sep 6, 2006
Last certification
Apr 20, 2021
Beds
106
Ownership / control type
Private (not for profit)
Organization structure
LLCNon-profit
Incorporated
Dec 2, 2004 in DE
Enrollment address
5000 San Bernardino St
Montclair, CA 91763-2326
Other Hospital Practice Location
Hospital subgroups
General

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Montclair Hospital Medical CenterCCN 050758 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

12598 Central Ave
Ste 219
Chino, CA 91710
Phone (909) 576-9503

13768 Roswell Ave
Ste 202
Chino, CA 91710
Phone (909) 606-2216

5365 Walnut Ave
Ste J
Chino, CA 91710

5385 Walnut Ave
Ste 6
Chino, CA 91710
Phone (909) 591-0311

1640 Newport Blvd
Ste 400
Costa Mesa, CA 92627
Phone (949) 386-5011

315 N 3rd Ave
Ste 206
Covina, CA 91723
Phone (626) 593-0695

9635 Monte Vista Ave
Ste 204
Montclair, CA 91763
Phone (909) 906-3446

9655 Monte Vista Ave
Ste 403
Montclair, CA 91763
Phone (909) 621-7321

1520 N Mountain Ave
#E122
Ontario, CA 91762
Phone (714) 696-8746

1700 N Waterman Ave
Ste 200
San Bernardino, CA 92404
Phone (909) 822-2323

2045 Royal Ave
Ste 221
Simi Valley, CA 93065
Phone (805) 581-3040

1317 W Foothill Blvd
Ste 148
Upland, CA 91786

637 N 13th Ave
Upland, CA 91786
Phone (909) 625-1977

18780 Amar Rd
Ste 107
Walnut, CA 91789
Phone (626) 810-6777

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Prime Healthcare Services, Inc Organization, Ontario, CA 5% Or Greater Indirect Ownership Interest Jan 1, 2011 100%
Other Jan 1, 2008
Steven Aleman Individual OtherChief Financial Officer Jun 1, 2020
Gail Aviado Individual Corporate OfficerChief Nursing Officer/Administrator May 1, 2003
Corporate DirectorGoverning Board Member May 1, 2019
W-2 Managing EmployeeChief Nursing Officer May 1, 2003
Christopher Doan Individual Corporate OfficerCheif Compliance Counsel Apr 24, 2017
Prime Healthcare Foundation Inc Organization, Ontario, CA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 31, 2010 100%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 95

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 95

Practitioners & affiliated clinicians

Practitioners 153

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 153

Affiliated clinicians 107

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 107

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1498608000000",
    "number": "1992721161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16850 BEAR VALLEY RD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955794",
            "telephone_number": "760-241-8222",
            "fax_number": "760-241-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 SAN BERNARDINO ST",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632326",
            "telephone_number": "909-625-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES - MONTCLAIR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2017-06-28",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF COMPLINANCE COUNSEL",
        "authorized_official_telephone_number": "909-235-4307",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montclair Hopsital Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montclair, CA

Sources for this page

Verify at the official NPI Registry.