Northridge Facial Plastic Surgery Medical Group a Professional Corp

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

S051366 Issued in CA

Legal business name

NORTHRIDGE FACIAL PLASTIC SURGERY MEDICAL GROUP A PROFESSIONAL CORP

Practice address

18350 Roscoe Blvd
#318A
Northridge, CA 91325-4109

Phone

(818) 993-9824

Fax

(818) 993-0937

NPI assigned

Aug 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Marc M Kerner, MDNPI 1275565608

Title

Medical Director

Phone

(818) 349-0600

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Northridge Facial Plastic Surgery Medical GroupCCN 05C0001366

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marc M Kerner, MD

  • Specialist
  • Northridge, CA
  • NPI 1275565608
  NPD Authorized official
• Ronald P. Accomazzo, MD

  • Specialist
  • Northridge, CA
  • NPI 1255359436
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1003824434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18350 ROSCOE BLVD # 318A",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254109",
            "telephone_number": "818-993-9824",
            "fax_number": "818-993-0937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18350 ROSCOE BLVD",
            "address_2": "#318A",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913254109",
            "telephone_number": "818-993-9824",
            "fax_number": "818-993-0937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHRIDGE FACIAL PLASTIC SURGERY MEDICAL GROUP A PROFESSIONAL CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "KERNER",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "818-349-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "S051366",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROV IDENTICA",
            "identifier": "ZZZH1907B",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "SO51366",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Northridge Community Boarding Care, Inc.
• Northridge Counseling Center
• Northridge Dermatology Associates Medical Group Inc
• Northridge Dialysis Center, LLC
• Northridge Emergency Medical Group
• Northridge Family Practice
• Northridge Family Practice Medical Group
• Northridge Free Clinic
• Northridge Golden Nest
• Northridge Home Health Inc.

• Ambulatory Surgical Clinic/Center in Northridge, CA
• Providers in Northridge, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.