FORMULA MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION
NPI 1710905690
Family Medicine in Apple Valley, CA
About Formula Medical Group A Professional Medical Corporation NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
FORMULA MEDICAL GROUP A PROFESSIONAL MEDICAL CORPORATION (NPI 1710905690) is a healthcare organization registered as a family medicine in Apple Valley, California and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through May 20, 2028 and lists James Krider, Doctor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Formula Medical Group A Professional Medical Corporation is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Formula Medical Group A Professional Medical Corporation, which bills Medicare for the services this clinician delivers.
Clinician (1)
Apple Valley, CA 92307
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 05D0718394
Formula Medical Group · Apple Valley, CAFrequently 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 Formula Medical Group A Professional Medical Corporation's NPI number?
The NPI number for Formula Medical Group A Professional Medical Corporation is 1710905690. It was assigned to this organization in the NPPES registry on July 18, 2006.
Where is Formula Medical Group A Professional Medical Corporation located?
Formula Medical Group A Professional Medical Corporation is located at 18182 Us Highway 18 Suite 105, Apple Valley, CA 92307. The listed phone number is (760) 242-1234.
What is Formula Medical Group A Professional Medical Corporation's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Formula Medical Group A Professional Medical Corporation enrolled in Medicare?
Yes. Formula Medical Group A Professional Medical Corporation is registered in the Medicare PECOS enrollment system.
When is Formula Medical Group A Professional Medical Corporation's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Formula Medical Group A Professional Medical Corporation?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Formula Medical Group A Professional Medical Corporation. 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 Formula Medical Group A Professional Medical Corporation hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D0718394) is associated with this NPI, valid through May 20, 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 Formula Medical Group A Professional Medical Corporation was last updated on May 14, 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.
# Formula Medical Group A Professional Medical Corporation · NPI 1710905690
Family Medicine organization in Apple Valley, California. Organization record, active in the CMS NPPES registry since July 18, 2006.
## Identity
- **NPI:** 1710905690 (Entity type: Organization)
- **Enumerated:** July 18, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** James Krider, DOCTOR
## Practice location
- **Address:** 18182 US HIGHWAY 18, SUITE 105, Apple Valley, CA 92307-2200
- **Phone:** (760) 242-1234 · **Fax:** (760) 242-5527
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, California, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** May 14, 2020
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1710905690) · Data from the CMS NPPES public registry.