Mission Grove Medical Corporation
NPI 1205224417ActiveOrganization· Internal Medicine, Pulmonary Disease· Riverside, CA
Internal Medicine, Pulmonary Disease in Riverside, California, registered in NPPES in December 2014. The authorized official on file is Sibonisiwe Moyo Johnson, Ao. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1205224417 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 23, 2014 |
| Last updated in NPPES | Sep 8, 2026 |
| Certified by provider | Sep 8, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine, Pulmonary Disease Primary | 207RP1001X | — | — |
| Clinic/Center, Urgent Care | 261QU0200X | A39116 | CA |
| Nurse Practitioner | 363L00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (CA) |
|---|
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