NPIMap

Organization Active NPI

Addis Medical Group a Medical Corporation

  • Psychiatry Physician
  • Torrance, CA
National Provider Identifier
1013289339
Registry record updated Sep 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A101106 Issued in CA
Legal business name
ADDIS MEDICAL GROUP A MEDICAL CORPORATION
Practice address
23700 Camino del Sol
Torrance, CA 90505-5017
Phone
(310) 530-1151
Fax
(310) 626-9390
NPI assigned
Feb 1, 2012
Last updated
Sep 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2014

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

Authorized official

Name
Dr. Hiruy H Gessesse, MDNPI 1902091481
Title
Owner
Phone
(424) 400-7748

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X A101106 CA Primary

Addresses

Primary practice location

23700 Camino del Sol
Torrance, CA 90505-5017

Mailing address

PO Box 4570
Palos Verdes Peninsula, CA 90274-9607
Phone (424) 400-7748

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120522001225 CA Part B Supplier - Clinic/Group Practice 0941463335 Receives reassigned benefits from 26 practitioners
Practice locations: Culver City, CA; Long Beach, CA; Panorama City, CA; Perris, CA; San Pedro, CA; Torrance, CA; Cerritos, CA

National Provider Directory

National Provider Directory

Locations

1201 Walnut Ave
Long Beach, CA 90813
Phone (562) 591-7621

330 N Hayworth Ave
Los Angeles, CA 90048
Phone (323) 224-4341

1322 W 6th St
San Pedro, CA 90732
Phone (310) 514-5270

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410393600000",
    "number": "1013289339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4570",
            "city": "PALOS VERDES PENINSULA",
            "state": "CA",
            "postal_code": "902749607",
            "telephone_number": "424-400-7748",
            "fax_number": "424-400-7749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23700 CAMINO DEL SOL",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905055017",
            "telephone_number": "310-530-1151",
            "fax_number": "310-626-9390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADDIS MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2014-09-11",
        "status": "A",
        "authorized_official_last_name": "GESSESSE",
        "authorized_official_first_name": "HIRUY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "424-400-7748",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A101106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; 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.