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PROVIDENCE MEDICAL FOUNDATION
NPI 1285890624
General Practice in Diamond Bar, CA

Active since August 05, 2008
1514 VALLEY VISTA DR, DIAMOND BAR, CA 91765(909) 860-1144(909) 860-8307 Get Directions Write a Review

NPPES record last updated: February 3, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Feb 3, 2026, May 5, 2021, Sep 11, 2017 (3 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 1285890624), doing business as St Joseph Heritage Healthcare, is a healthcare organization registered as a general practice in Diamond Bar, California and active in the NPI registry since August 2008. The organization lists Donald W. Anderson, Assistant Secretary Of Enrollments, as its authorized official.

NPPES Registry Identity

NPI1285890624
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NamePROVIDENCE MEDICAL FOUNDATION
Location Address1514 VALLEY VISTA DRDiamond Bar, CA 91765-3929
Mailing AddressPo Box 31001 - 1920Pasadena, CA 91110-1920 · (714) 449-4800 · Fax (714) 449-4956
Phone(909) 860-1144
Fax(909) 860-8307
Organization SubpartNo
Authorized OfficialDonald W. AndersonAssistant Secretary Of Enrollments · (425) 358-9786
Enumeration DateAugust 5, 2008
Last NPPES UpdateFebruary 3, 20263 updates tracked since enumeration
NPPES CertifiedFebruary 3, 2026
✔ NPI 1285890624 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
1514 VALLEY VISTA DR, Diamond Bar, CA 91765
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Other Names 2

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

Other Identifiers 1

OtherCG4895CA · Railroad Medicare Provider Number

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)

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, 9 practice at this address and 289 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
Brian Koffman, MD
Family Practice
NPI 1326049164
1514 VALLEY VISTA DR
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOSSame address
Sandra Mathur, DO
Pediatric Medicine
NPI 1841250974
1514 VALLEY VISTA DR
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOSSame address
Parvita Panchal, DO
Family Practice
NPI 1730683145
1514 VALLEY VISTA DR
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts MedicareSame address
Wilfredo Alejo, M.D.
Pediatric Medicine
NPI 1114990785
1514 VALLEY VISTA DR
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOSSame address
Jing Chen, M.D.
Pediatric Medicine
NPI 1699208942
1514 VALLEY VISTA DR
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOSSame address
Eric Lee, DO
Family Practice
NPI 1801208707
1514 VALLEY VISTA DR
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts MedicareSame address
Aaron Lin, D.O.
Family Practice
NPI 1053706309
1514 VALLEY VISTA DR ST JUDE HERITAGE MEDICAL GROUP
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts MedicareSame address
Sarom Pyun, M.D.
Family Practice
NPI 1104264472
1514 VALLEY VISTA DR
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts MedicareSame address
Douglas Starr, MD
Family Practice
NPI 1154322998
1514 VALLEY VISTA DR
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts MedicareSame address
Ruby Banuelos Calhoun, LCSW
Clinical Social Worker
NPI 1902379985
253 S DIAMOND BAR BLVD
Diamond Bar, CA 91765
(909) 396-7025
✔ PECOS2.5 mi
Lilian Li, DO
Family Practice
NPI 1730717737
253 S DIAMOND BAR BLVD
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts Medicare2.5 mi
Anne Liao, MD
Obstetrics/Gynecology
NPI 1164099487
253 S DIAMOND BAR BLVD
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts Medicare2.5 mi
Jessica Mac, LCSW
Clinical Social Worker
NPI 1326561382
253 S DIAMOND BAR BLVD
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS2.5 mi
David Rhodes, MD
Family Practice
NPI 1518968353
253 S DIAMOND BAR BLVD
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts Medicare2.5 mi
Verina Salib, MSN, WHNP-BC
Nurse Practitioner
NPI 1972377067
253 S DIAMOND BAR BLVD
Diamond Bar, CA 91765
(909) 929-2513
✔ PECOS✔ Accepts Medicare2.5 mi
Kim Tran, DO
Family Practice
NPI 1518491836
253 S DIAMOND BAR BLVD
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts Medicare2.5 mi
Emily Du, MD
Obstetrics/Gynecology
NPI 1669933552
253 S DIAMOND BAR BLVD
Diamond Bar, CA 91765
(909) 860-1144
✔ PECOS✔ Accepts Medicare2.5 mi
Adrian Bose, M.D.
Critical Care (Intensivists)
NPI 1104032630
875 N. BREA BLVD.
Brea, CA 92821
(714) 529-6842
✔ PECOS✔ Accepts Medicare5.2 mi
Angelia Sidarta, D.O.
Family Practice
NPI 1790731776
500 W CENTRAL AVE SUITE B
Brea, CA 92821
(714) 671-0766
✔ PECOS✔ Accepts Medicare5.7 mi
Sothy Pheng, MD
Internal Medicine
NPI 1083697007
2961 OAKBERRY CT
Fullerton, CA 92835
(978) 551-8088
✔ PECOS✔ Accepts Medicare6.4 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 1285890624. It was assigned to this organization in the NPPES registry on August 5, 2008. 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 1514 Valley Vista Dr, Diamond Bar, CA 91765. The listed phone number is (909) 860-1144.

What is Providence Medical Foundation's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

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, 9 practice at this address and 289 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 February 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.