1. Home
  2. Directory
  3. California
  4. Apple Valley
  5. Urology
  6. NPI Profile

PROVIDENCE MEDICAL FOUNDATION
NPI 1053616706
Urology in Apple Valley, CA

Active since January 11, 2011
19333 BEAR VALLEY RD, SUITE 106, APPLE VALLEY, CA 92308(760) 240-5505(760) 245-5525 Get Directions Write a Review

NPPES record last updated: December 1, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Dec 1, 2025, Mar 17, 2025, May 5, 2021 and 1 more (4 updates tracked since 2017).

About Providence Medical Foundation NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE MEDICAL FOUNDATION (NPI 1053616706), doing business as St Joseph Heritage Healthcare, is a healthcare organization registered as an urology in Apple Valley, California and active in the NPI registry since January 2011. The organization lists Donald W. Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1053616706
Entity TypeOrganization
Primary Taxonomy208800000X
Legal Business NamePROVIDENCE MEDICAL FOUNDATION
Location Address19333 BEAR VALLEY RD, SUITE 106Apple Valley, CA 92308-5148
Mailing AddressPo Box 31001 - 1920Pasadena, CA 91110-1920 · (714) 449-4800 · Fax (714) 449-4956
Phone(760) 240-5505
Fax(760) 245-5525
Organization SubpartNo
Authorized OfficialDonald W. AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateJanuary 11, 2011
Last NPPES UpdateDecember 1, 20254 updates tracked since enumeration
NPPES CertifiedDecember 1, 2025
✔ NPI 1053616706 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyUrologyAllopathic & Osteopathic Physicians
Taxonomy Code208800000X
Definition
A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.
Also ListedClinic/Center · RadiologyTaxonomy 261QR0200X
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
19333 BEAR VALLEY RD, Apple Valley, CA 92308
Open in Google Maps ↗

Other Names 2

Former Legal Business NameSt Joseph Heritage Healthcare
Former Legal Business NameSt Jude Hospital Yorba Linda

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Medical Foundation is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

1,692

Medicare enrollment records show 1,692 clinicians reassign Medicare billing to Providence Medical Foundation, which bills Medicare for the services they deliver. Of these, 6 practice at this address and 52 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 61

Nurse Practitioner274
Internal Medicine234
Family Practice232
Pediatric Medicine79
Emergency Medicine73
Hospitalist64
Obstetrics/Gynecology63
Cardiovascular Disease (Cardiology)62
53 other specialties611

Nearest to this location (20)

See all 1,692
Brooke Snow, FNP
Nurse Practitioner
NPI 1720829294
19333 BEAR VALLEY RD STE 205
Apple Valley, CA 92308
(760) 241-6666
✔ PECOS✔ Accepts MedicareSame address
Blake Daly, RD
Registered Dietitian or Nutrition Professional
NPI 1568148336
19333 BEAR VALLEY RD STE 103
Apple Valley, CA 92308
(714) 618-9500
Same address
Tsz Man Tong, DO
Family Practice
NPI 1679192934
19333 BEAR VALLEY RD STE 205
Apple Valley, CA 92308
(760) 241-6666
✔ PECOS✔ Accepts MedicareSame address
Kavit Desouza, M.D.
Interventional Cardiology
NPI 1245441997
19341 BEAR VALLEY RD STE 105
Apple Valley, CA 92308
(760) 247-6444
✔ PECOS✔ Accepts MedicareSame address
Sarah Noppen, D.O.
Obstetrics/Gynecology
NPI 1649533274
19341 BEAR VALLEY RD STE 105
Apple Valley, CA 92308
(760) 247-6444
✔ PECOS✔ Accepts MedicareSame address
Bashar Shahatit, M.D.
Family Practice
NPI 1831416742
19341 BEAR VALLEY RD STE 104
Apple Valley, CA 92308
(760) 956-4148
✔ PECOS✔ Accepts MedicareSame address
Janet Warren, NP
Nurse Practitioner
NPI 1467792051
19341 BEAR VALLEY RD STE 105
Apple Valley, CA 92308
(760) 241-6666
✔ PECOS✔ Accepts Medicare0.1 mi
Lisa Morales, FNP
Nurse Practitioner
NPI 1619456449
17259 JASMINE ST
Victorville, CA 92395
(760) 843-9414
✔ PECOS✔ Accepts Medicare2.6 mi
Maggie Valencia, FNP
Nurse Practitioner
NPI 1811622913
12677 HESPERIA RD STE 160
Victorville, CA 92395
(760) 372-9709
✔ PECOS✔ Accepts Medicare2.8 mi
Harikrishna Makani
Cardiovascular Disease (Cardiology)
NPI 1407169485
12370 HESPERIA RD SUITE 6
Victorville, CA 92395
(760) 245-4747
✔ PECOS✔ Accepts Medicare2.9 mi
Zoheir El-Hajjaoui, M.D.
Internal Medicine
NPI 1831199058
12550 HESPERIA RD SUITE 100
Victorville, CA 92395
(760) 241-6666
✔ PECOS✔ Accepts Medicare2.9 mi
Pushpinder Guleria, M.D.
Endocrinology
NPI 1366521825
12550 HESPERIA RD STE 100
Victorville, CA 92395
(760) 381-7705
✔ PECOS✔ Accepts Medicare2.9 mi
Paul Lee, MD
Family Practice
NPI 1497105951
12550 HESPERIA RD STE 100
Victorville, CA 92395
(760) 241-6666
✔ PECOS✔ Accepts Medicare2.9 mi
Madeline Ong Veloso, N.P.
Nurse Practitioner
NPI 1629027305
12550 HESPERIA ROAD SUITE 100
Victorville, CA 92395
(760) 241-6666
✔ PECOS✔ Accepts Medicare2.9 mi
Vincent Covelli, D.O.
Internal Medicine
NPI 1528354347
12550 HESPERIA RD STE 100
Victorville, CA 92395
(760) 241-6666
✔ PECOS✔ Accepts Medicare2.9 mi
Mark Mousa, MD
Family Practice
NPI 1104497684
12550 HESPERIA RD STE 100
Victorville, CA 92395
(760) 241-6666
✔ PECOS✔ Accepts Medicare2.9 mi
Matthew Mercado
Clinical Social Worker
NPI 1851701320
12830 HESPERIA RD STE CD
Victorville, CA 92395
(760) 684-8999
✔ PECOS✔ Accepts Medicare3.0 mi
Mark Potes, MD
Family Practice
NPI 1295438752
17043 MAIN ST
Hesperia, CA 92345
(760) 241-6666
✔ PECOS4.4 mi
Martha Garcia, PA-C
Physician Assistant
NPI 1487604427
17095 MAIN ST
Hesperia, CA 92345
(760) 241-6666
✔ PECOS✔ Accepts Medicare4.5 mi
Suehong Tao, MD
Pediatric Medicine
NPI 1588639314
17083 MAIN ST
Hesperia, CA 92345
(760) 241-6666
✔ PECOS4.5 mi
See all 1,692 clinicians

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Medical Foundation's NPI number?

The NPI number for Providence Medical Foundation is 1053616706. It was assigned to this organization in the NPPES registry on January 11, 2011. The provider was formerly known as St Joseph Heritage Healthcare and St Jude Hospital Yorba Linda.

Where is Providence Medical Foundation located?

Providence Medical Foundation is located at 19333 Bear Valley Rd Suite 106, Apple Valley, CA 92308. The listed phone number is (760) 240-5505.

What is Providence Medical Foundation's specialty?

The primary specialty registered for this NPI is Urology with taxonomy code 208800000X.

Is Providence Medical Foundation enrolled in Medicare?

Yes. Providence Medical Foundation is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Medical Foundation?

According to the CMS Revalidation Reassignment List (October 2026 release), 1,692 clinicians in 61 Medicare specialties reassign their Medicare billing to Providence Medical Foundation. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (274), Internal Medicine (234) and Family Practice (232). Of these, 6 practice at this address and 52 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Providence Medical Foundation was last updated on December 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.