Glendale Community Medical Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A45958 Issued in CA

Legal business name

GLENDALE COMMUNITY MEDICAL GROUP INC

Practice address

801 S Chevy Chase Dr
105
Glendale, CA 91205-4431

Phone

(818) 265-2203

Fax

(818) 265-2201

NPI assigned

Sep 13, 2007

Organization subpart

No

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

Authorized official

Name

Duc C Bui, M.D.NPI 1831170950

Title

President

Phone

(818) 265-2203

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Glendale Community Medical Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Glendale Community Medical Group, Inc.

  • Nephrology Physician
  • Glendale, CA
  • NPI 1679564934
  NPD tax ID

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

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

• Duc Cong Bui, M.D.

  • Nephrology Physician
  • Glendale, CA
  • NPI 1831170950
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198627200000",
    "number": "1013102854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 S CHEVY CHASE DR",
            "address_2": "105",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912054431",
            "telephone_number": "818-265-2203",
            "fax_number": "818-265-2201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 S CHEVY CHASE DR",
            "address_2": "105",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912054431",
            "telephone_number": "818-265-2203",
            "fax_number": "818-265-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALE COMMUNITY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2007-12-26",
        "status": "A",
        "authorized_official_last_name": "BUI",
        "authorized_official_first_name": "DUC",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-265-2203",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A45958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A459580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Glendale Back and Pain Center
• Glendale Care Home Health
• Glendale City Optometry, Inc.
• Glendale Community Care Pharmacy Inc
• Glendale Community Family Practice Inc.
• Glendale Community Medical Group, Inc.
• Glendale Counseling Services
• Glendale CV Operating Company, LLC
• Glendale Dental Center
• Glendale Dental Center Majid Ghorbani DDS Inc.

• Specialist in Glendale, CA
• Providers in Glendale, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.