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REGENERATIVE MEDICAL GROUP INC
NPI 1366051419
Family Medicine in Idyllwild, CA

Active since July 24, 2020CLIA 05D2211572 · Waiver
54910, PINE CREST AVENUE, IDYLLWILD, CA 92549(951) 659-9912 Get Directions Write a Review

NPPES record last updated: July 24, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Regenerative Medical Group Inc NPPES

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

REGENERATIVE MEDICAL GROUP INC (NPI 1366051419) is a healthcare organization registered as a family medicine in Idyllwild, California and active in the NPI registry since July 2020. The organization holds a CLIA Waiver certificate valid through January 27, 2027 and lists Bryn Jarald Henderson, Owner, as its authorized official.

NPPES Registry Identity

NPI1366051419
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameREGENERATIVE MEDICAL GROUP INC
Location Address54910, PINE CREST AVENUEIdyllwild, CA 92549
Mailing Address54910, Pine Crest AvenueIdyllwild, CA 92549
Phone(951) 659-9912
Organization SubpartYes
Authorized OfficialBryn Jarald HendersonOwner · (714) 639-4012
Enumeration DateJuly 24, 2020
NPPES CertifiedJuly 24, 2020
✔ NPI 1366051419 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
54910, PINE CREST AVENUE, Idyllwild, CA 92549
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

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 05D2211572

Regenerative Medical Group · Idyllwild, CA
Active · expires Jan 27, 2027
CLIA Number05D2211572
Laboratory TypePhysician Office
Certificate Effective DateJanuary 28, 2025
Certificate Expiration DateJanuary 27, 2027
Laboratory DirectorBryn Henderson
Laboratory Phone(714) 551-9576
Laboratory LocationRegenerative Medical Group54910 Pincrest Avenue, Idyllwild, CA 92549
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JODI ANN SUTHERLAND
Nutritionist (Nutrition, Education)
54910, PINE CREST AVENUE
IDYLLWILD, CA 92549
Riverside County (951) 659-9912

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 Regenerative Medical Group Inc's NPI number?

The NPI number for Regenerative Medical Group Inc is 1366051419. It was assigned to this organization in the NPPES registry on July 24, 2020.

Where is Regenerative Medical Group Inc located?

Regenerative Medical Group Inc is located at 54910, Pine Crest Avenue, Idyllwild, CA 92549. The listed phone number is (951) 659-9912.

What is Regenerative Medical Group Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Regenerative Medical Group Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2211572) is associated with this NPI, valid through January 27, 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 Regenerative Medical Group Inc was last updated on July 24, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.