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MISSION UROLOGY
NPI 1063874337
Urology in Riverside, CA

Active since March 24, 2016CLIA 05D2133704 · Microscopy
4500 BROCKTON AVE, SUITE 301, RIVERSIDE, CA 92501(951) 276-4505(951) 276-4517 Get Directions Write a Review

NPPES record last updated: June 24, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 20, 2019, Mar 24, 2016 (2 updates tracked since 2016).

About Mission Urology NPPES

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

MISSION UROLOGY (NPI 1063874337) is a healthcare organization registered as an urology in Riverside, California and active in the NPI registry since March 2016. The organization holds a CLIA Microscopy certificate valid through July 17, 2027 and lists Jo-ann Mendoza, President, as its authorized official.

NPPES Registry Identity

NPI1063874337
Entity TypeOrganization
Primary Taxonomy208800000X
Legal Business NameMISSION UROLOGY, INC.
Location Address4500 BROCKTON AVE, SUITE 301Riverside, CA 92501-4027
Mailing AddressPo Box 7270Moreno Valley, CA 92552-7270 · (951) 656-1500 · Fax (951) 656-1510
Phone(951) 276-4505
Fax(951) 276-4517
Organization SubpartNo
Authorized OfficialJo-ann MendozaPresident · (951) 276-4505
Enumeration DateMarch 24, 2016
Last NPPES UpdateJune 24, 20192 updates tracked since enumeration
✔ NPI 1063874337 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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 ListedInternal MedicineTaxonomy 207R00000X
4500 BROCKTON AVE, Riverside, CA 92501
Open in Google Maps ↗

Other Names 1

Doing Business AsMission Urology

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mission Urology is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Mission Urology, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Ken Takesita, M.D.
Urology
NPI 1629243837
4500 BROCKTON AVE STE 301
Riverside, CA 92501
(951) 276-4505
✔ PECOS✔ Accepts MedicareSame address
Sy Tsi, MD
Urology
NPI 1194743864
801 S. MAIN ST. SUITE 201
Corona, CA 92882
(951) 735-2700
✔ PECOS✔ Accepts Medicare13 mi

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D2133704

Mission Urology · Riverside, CA
Active · expires Jul 17, 2027
CLIA Number05D2133704
Laboratory TypePhysician Office
Certificate Effective DateJuly 18, 2025
Certificate Expiration DateJuly 17, 2027
Laboratory DirectorTimothy J. Pietro
Laboratory Phone(951) 276-4505
Laboratory LocationMission Urology4500 Brockton Ave Ste 301, Riverside, CA 92501
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

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 Mission Urology, Inc.'s NPI number?

The NPI number for Mission Urology, Inc. is 1063874337. It was assigned to this organization in the NPPES registry on March 24, 2016. The provider is doing business as Mission Urology.

Where is Mission Urology, Inc. located?

Mission Urology, Inc. is located at 4500 Brockton Ave Suite 301, Riverside, CA 92501. The listed phone number is (951) 276-4505.

What is Mission Urology, Inc.'s specialty?

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

Is Mission Urology, Inc. enrolled in Medicare?

Yes. Mission Urology, Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Mission Urology, Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Urology, reassign their Medicare billing to Mission Urology, Inc.. 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. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Mission Urology, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 05D2133704) is associated with this NPI, valid through July 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Mission Urology, Inc. was last updated on June 24, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years 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.