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PLATINUM PROVIDERS MEDICAL GROUP INC
NPI 1275018392
Internal Medicine in Riverside, CA

Active since September 25, 2018CLIA 05D2159732 · Waiver
6900 BROCKTON AVE STE 100, RIVERSIDE, CA 92506(951) 781-3800(951) 781-1973 Get Directions Write a Review

NPPES record last updated: March 20, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 20, 2026, Nov 12, 2025, Aug 6, 2025 and 2 more (5 updates tracked since 2018).

About Platinum Providers Medical Group Inc NPPES

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

PLATINUM PROVIDERS MEDICAL GROUP INC (NPI 1275018392) is a healthcare organization registered as an internal medicine in Riverside, California and active in the NPI registry since September 2018. The organization holds a CLIA Waiver certificate valid through December 23, 2026 and lists Robert G Nelson, President, as its authorized official.

NPPES Registry Identity

NPI1275018392
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePLATINUM PROVIDERS MEDICAL GROUP INC
Location Address6900 BROCKTON AVE STE 100Riverside, CA 92506-3817
Mailing Address2250 S Main St Ste 209Corona, CA 92882-2507 · (951) 781-3800
Phone(951) 781-3800
Fax(951) 781-1973
Organization SubpartNo
Authorized OfficialRobert G NelsonPresident · (951) 737-8141
Enumeration DateSeptember 25, 2018
Last NPPES UpdateMarch 20, 20265 updates tracked since enumeration
NPPES CertifiedMarch 20, 2026
✔ NPI 1275018392 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedFamily MedicineTaxonomy 207Q00000X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
6900 BROCKTON AVE STE 100, Riverside, CA 92506
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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)

Platinum Providers Medical Group Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Platinum Providers Medical Group Inc, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

John Agtuca, D.O.
Internal Medicine
NPI 1306200183
6900 BROCKTON AVE STE 100
Riverside, CA 92506
(951) 781-3800
✔ PECOS✔ Accepts MedicareSame address
Peter Mattar, MD
Family Practice
NPI 1417005422
9961 SIERRA AVE
Fontana, CA 92335
(909) 427-3910
✔ PECOS✔ Accepts Medicare8.8 mi
Renanda Stevenson, DNP, FNP-BC
Nurse Practitioner
NPI 1366687113
1901 TOWN AND COUNTRY DR STE 104
Norco, CA 92860
(951) 737-8141
✔ PECOS✔ Accepts Medicare9.6 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 of Waiver 05D2159732

Platinum Providers Medical Group · Riverside, CA
Active · expires Dec 23, 2026
CLIA Number05D2159732
Laboratory TypePhysician Office
Certificate Effective DateDecember 24, 2024
Certificate Expiration DateDecember 23, 2026
Laboratory DirectorPeter N. Mattar
Laboratory Phone(951) 781-3800
Laboratory LocationPlatinum Providers Medical Group6900 Brockton Ave Suite 100, Riverside, CA 92506
CLIA data matches this NPI record on: Address 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 Platinum Providers Medical Group Inc's NPI number?

The NPI number for Platinum Providers Medical Group Inc is 1275018392. It was assigned to this organization in the NPPES registry on September 25, 2018.

Where is Platinum Providers Medical Group Inc located?

Platinum Providers Medical Group Inc is located at 6900 Brockton Ave Ste 100, Riverside, CA 92506. The listed phone number is (951) 781-3800.

What is Platinum Providers Medical Group Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Platinum Providers Medical Group Inc enrolled in Medicare?

Yes. Platinum Providers Medical Group Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Platinum Providers Medical Group Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Platinum Providers Medical Group Inc, in Family Practice, Internal Medicine and Nurse Practitioner. 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 and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Platinum Providers Medical Group Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2159732) is associated with this NPI, valid through December 23, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Platinum Providers Medical Group Inc was last updated on March 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.