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PARK SIERRA MEDICAL CLINIC INC
NPI 1184833428
Clinic/Center in Colton, CA

Active since May 22, 2007CLIA 05D1077520 · Waiver
1023 S MOUNT VERNON AVE STE A, COLTON, CA 92324(909) 533-4443(909) 533-4483 Get Directions Write a Review

NPPES record last updated: September 9, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Park Sierra Medical Clinic Inc NPPES

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

PARK SIERRA MEDICAL CLINIC INC (NPI 1184833428) is a healthcare organization registered as a clinic/center in Colton, California and active in the NPI registry since May 2007. The organization holds a CLIA Waiver certificate valid through January 12, 2028 and lists Anil Donald Mall, Owner, as its authorized official.

NPPES Registry Identity

NPI1184833428
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NamePARK SIERRA MEDICAL CLINIC INC
Location Address1023 S MOUNT VERNON AVE STE AColton, CA 92324-4202
Mailing Address1023 S Mount Vernon Ave Ste AColton, CA 92324-4202 · (909) 533-4443 · Fax (909) 533-4483
Phone(909) 533-4443
Fax(909) 533-4483
Organization SubpartNo
Authorized OfficialAnil Donald MallOwner · (909) 533-4443
Enumeration DateMay 22, 2007
Last NPPES UpdateSeptember 9, 2021
NPPES CertifiedSeptember 9, 2021
✔ NPI 1184833428 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
1023 S MOUNT VERNON AVE STE A, Colton, CA 92324
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Park Sierra Medical Clinic Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Park Sierra Medical Clinic Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Anil Mall, M.D.
Family Practice
NPI 1285656900
1023 S MOUNT VERNON AVE STE A
Colton, CA 92324
(909) 533-4443
✔ PECOS✔ Accepts MedicareSame address

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 of Waiver 05D1077520

Park Sierra Medical Clinic, Inc · Colton, CA
Active · expires Jan 12, 2028
CLIA Number05D1077520
Laboratory TypePhysician Office
Certificate Effective DateJanuary 13, 2026
Certificate Expiration DateJanuary 12, 2028
Laboratory DirectorAnil D. Mall
Laboratory Phone(909) 533-4443
Laboratory LocationPark Sierra Medical Clinic, Inc1023 South Mount Vernon Avenue Suite N3, Colton, CA 92324
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only 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 Park Sierra Medical Clinic Inc's NPI number?

The NPI number for Park Sierra Medical Clinic Inc is 1184833428. It was assigned to this organization in the NPPES registry on May 22, 2007.

Where is Park Sierra Medical Clinic Inc located?

Park Sierra Medical Clinic Inc is located at 1023 S Mount Vernon Ave Ste A, Colton, CA 92324. The listed phone number is (909) 533-4443.

What is Park Sierra Medical Clinic Inc's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Park Sierra Medical Clinic Inc enrolled in Medicare?

Yes. Park Sierra Medical Clinic Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Park Sierra Medical Clinic Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Park Sierra Medical Clinic 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Park Sierra Medical Clinic Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D1077520) is associated with this NPI, valid through January 12, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Park Sierra Medical Clinic Inc was last updated on September 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.