Premier ENT a Medical Corp

Primary specialty

SpecialistTaxonomy code 174400000X

License

A50970 Issued in CA

Legal business name

PREMIER ENT A MEDICAL CORP

Practice address

255 Terracina Blvd
Suite 201
Redlands, CA 92373-4870

Phone

(909) 793-2500

Fax

(951) 845-2181

NPI assigned

Jul 5, 2007

Organization subpart

No

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

Authorized official

Name

Sharen Knudsen Jeffries, M.D.NPI 1386643534

Title

Owner

Phone

(909) 793-2500

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

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

• Sharen Knudsen Jeffries, M.D.

  • Otolaryngology Physician
  • Redlands, CA
  • NPI 1386643534
  Medicare reassignment NPD Authorized official
• Pamela Ann Gray, PA

  • Surgical Physician Assistant
  • Carmel, IN
  • NPI 1558696328

  CA

  Medicare reassignment

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228089600000",
    "number": "1992903686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 TERRACINA BLVD",
            "address_2": "SUITE 201",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734870",
            "telephone_number": "909-793-2500",
            "fax_number": "951-845-2181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 TERRACINA BLVD",
            "address_2": "SUITE 201",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923734870",
            "telephone_number": "909-793-2500",
            "fax_number": "951-845-2181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER ENT A MEDICAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2008-12-01",
        "status": "A",
        "authorized_official_last_name": "JEFFRIES",
        "authorized_official_first_name": "SHAREN",
        "authorized_official_middle_name": "KNUDSEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-793-2500",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A50970",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Letitia Pragasam, DDS
• Kaytie Rose Prater
• Janae Preast Hewes, LMFT
• Preferred Medical Office Inc
• Premier Care Transportation LLC
• Premier Hearing Aid & Audiology
• Kareen Dawn Premmer, M.D.
• Jason W. Preuschoff, PT
• Primary Critical Care Limited Partnership
• Prior Level Home Care Physical Therapy Inc.

• Specialist in Redlands, CA
• Providers in Redlands, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2008; 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.