Basic Information
| Provider Information | |||||||||
| NPI: | 1760435705 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAREMORE MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 275 | ||||||||
| Address2: | ATTENTION: CREDENTIALING MS-6165 | ||||||||
| City: | ARTESIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907020275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622824026 | ||||||||
| FaxNumber: | 5626222971 | ||||||||
| Practice Location | |||||||||
| Address1: | 12900 PARK PLAZA DR STE 150 | ||||||||
| Address2: | ATTENTION: M. DIANE CADY MS-6160 | ||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622824026 | ||||||||
| FaxNumber: | 5626222971 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 05/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | MERCER | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5627414461 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 208000000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208100000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RE0101X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RG0100X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | 207RG0300X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | 207RP1001X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0056492 | 05 | CA | MEDICAID | GR005649B | 05 | CA | MEDICAID | GR0084272 | 05 | CA | MEDICAID | GR0084275 | 05 | CA | MEDICAID | GR0056493 | 05 | CA | MEDICAID | GR0056495 | 05 | CA | MEDICAID | GR005649P | 05 | CA | MEDICAID | GR005649C | 05 | CA | MEDICAID | GR0084276 | 05 | CA | MEDICAID | GR0056494 | 05 | CA | MEDICAID | GR005649X | 05 | CA | MEDICAID | GR0084271 | 05 | CA | MEDICAID | GR0084274 | 05 | CA | MEDICAID | GR005649U | 05 | CA | MEDICAID | DF3950 | 01 | CA | RAILROAD MEDICARE | OTHER | GR0084270 | 05 | CA | MEDICAID | GR005649M | 05 | CA | MEDICAID | GR005649V | 05 | CA | MEDICAID |