Myrtle Medical Center Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A33654 Issued in CA

Legal business name

MYRTLE MEDICAL CENTER INC

Practice address

416 S Myrtle Ave
Monrovia, CA 91016-2812

Phone

(626) 357-3296

Fax

(626) 359-5608

NPI assigned

Dec 20, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Peter C. Balacuit, M.D.

Title

President

Phone

(626) 357-3296

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Peter C. Balacuit M.D. Inc. Former legal business name

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)…

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

{
    "created_epoch": "1292803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557792000000",
    "number": "1013210756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 S MYRTLE AVE",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910162812",
            "telephone_number": "626-357-3296",
            "fax_number": "626-359-5608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 S MYRTLE AVE",
            "city": "MONROVIA",
            "state": "CA",
            "postal_code": "910162812",
            "telephone_number": "626-357-3296",
            "fax_number": "626-359-5608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYRTLE MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-20",
        "last_updated": "2019-05-14",
        "status": "A",
        "authorized_official_last_name": "BALACUIT",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "626-357-3296",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A33654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A336540",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Peter C. Balacuit M.D. Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Kayla Myers
• Madison Myers
• Darrin Myles
• Goldie Myree
• Kendall Myrick
• Kiara Myton
• Emily Nabayan
• Tierra Nabors
• Lauren Nadeau
• Adam Nadeem

• Family Medicine Physician in Monrovia, CA
• Providers in Monrovia, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.