1. Home
  2. Directory
  3. California
  4. Perris
  5. Family Medicine
  6. NPI Profile

POOM MEDICAL CLINIC INC
NPI 1831548197
Family Medicine in Perris, CA

Active since June 08, 2016CLIA 05D0690392 · Waiver
2055 N PERRIS BLVD STE E6, PERRIS, CA 92571(951) 940-4176(951) 940-4038 Get Directions Write a Review

NPPES record last updated: June 8, 2016. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Poom Medical Clinic Inc NPPES

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

POOM MEDICAL CLINIC INC (NPI 1831548197) is a healthcare organization registered as a family medicine in Perris, California and active in the NPI registry since June 2016. The organization holds a CLIA Waiver certificate valid through November 17, 2027 and lists Lida Poommipanit-bajon, Secretary, as its authorized official.

NPPES Registry Identity

NPI1831548197
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePOOM MEDICAL CLINIC INC
Location Address2055 N PERRIS BLVD STE E6Perris, CA 92571-2517
Mailing Address16293 Regency Ranch RdRiverside, CA 92504-5654 · (808) 419-1187
Phone(951) 940-4176
Fax(951) 940-4038
Organization SubpartNo
Authorized OfficialLida Poommipanit-bajonSecretary · (808) 419-1187
Enumeration DateJune 8, 2016
✔ NPI 1831548197 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in CA · A 70122
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.
2055 N PERRIS BLVD STE E6, Perris, CA 92571
Open in Google Maps ↗

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 SINGLE 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)

Poom 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 Poom Medical Clinic Inc, which bills Medicare for the services this clinician delivers.

Clinician (1)

Lida Poommipanit-Bajon, MD
Family Practice
NPI 1861563413
2055 N PERRIS BLVD E6
Perris, CA 92571
(951) 940-4176
✔ 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 05D0690392

Poom Medical Clinic · Perris, CA
Active · expires Nov 17, 2027
CLIA Number05D0690392
Laboratory TypePhysician Office
Certificate Effective DateNovember 18, 2025
Certificate Expiration DateNovember 17, 2027
Laboratory DirectorLida Poommipanit-Bajon MD
Laboratory Phone(951) 940-4176
Laboratory LocationPoom Medical Clinic2055 N Perris Blvd Ste E6, Perris, CA 92571
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 Poom Medical Clinic Inc's NPI number?

The NPI number for Poom Medical Clinic Inc is 1831548197. It was assigned to this organization in the NPPES registry on June 8, 2016.

Where is Poom Medical Clinic Inc located?

Poom Medical Clinic Inc is located at 2055 N Perris Blvd Ste E6, Perris, CA 92571. The listed phone number is (951) 940-4176.

What is Poom Medical Clinic Inc's specialty?

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

Is Poom Medical Clinic Inc enrolled in Medicare?

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

How many clinicians bill Medicare through Poom Medical Clinic Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Poom 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 Poom Medical Clinic Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0690392) is associated with this NPI, valid through November 17, 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 Poom Medical Clinic Inc was last updated on June 8, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.