| Innovative Medical Group | |
|
4500 Brockton Ave Ste 305 Riverside CA 92501-4027 | |
| (206) 445-9978 | |
| (858) 280-3279 |
| Full Name | Innovative Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 4500 Brockton Ave Ste 305, Riverside, California |
| Authorized Official Name and Position | Cheryl Lee (DIRECTOR CREDENTIALING) |
| Authorized Official Contact | 7257109159 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovative Medical Group 44045 Margarita Rd Ste 102 Temecula CA 92592-2729 Ph: (951) 517-7916 | Innovative Medical Group 4500 Brockton Ave Ste 305 Riverside CA 92501-4027 Ph: (206) 445-9978 |
| NPI Number | 1003407735 |
|---|---|
| Provider Enumeration Date | 01/26/2021 |
| Last Update Date | 05/23/2023 |
| Medicare PECOS PAC ID | 1759797251 |
|---|---|
| Medicare Enrollment ID | O20210308002622 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003407735 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Sivaraman K Gounder |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740436237 PECOS PAC ID: 8426196825 Enrollment ID: I20110322000719 |
| Provider Name | Haena Min |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1437387792 PECOS PAC ID: 0648422733 Enrollment ID: I20140203000929 |
| Provider Name | Richard C Jin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053754366 PECOS PAC ID: 4880990597 Enrollment ID: I20170208002901 |
| Provider Name | Ronald M Atillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346747391 PECOS PAC ID: 3971853243 Enrollment ID: I20180906003011 |
| Provider Name | Kirk Anthony Hall |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710406848 PECOS PAC ID: 8820334824 Enrollment ID: I20190111002541 |
| Provider Name | Anam Azhar Goraya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1174082432 PECOS PAC ID: 1557744422 Enrollment ID: I20220810003263 |
| Provider Name | Anesh Patel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1558820845 PECOS PAC ID: 6305229196 Enrollment ID: I20220811000568 |
| Provider Name | Qais Ayouby |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154884351 PECOS PAC ID: 9931582608 Enrollment ID: I20220812000382 |
| Provider Name | Shawn Mo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033679873 PECOS PAC ID: 2668856667 Enrollment ID: I20220824003366 |
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