NPIMap

Individual provider Active NPI

Edgar Alexander Chavez, MD

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1023216678
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A92965 Issued in CA
Practice address
1005 E Washington Blvd Ste a
Los Angeles, CA 90021-3020
Phone
(323) 233-3100
Fax
(213) 745-3626
NPI assigned
Jul 5, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A92965 CA Primary

Addresses

Primary practice location

1005 E Washington Blvd Ste a
Los Angeles, CA 90021-3020

Mailing address

2801 S San Pedro St
Los Angeles, CA 90011-2023
Phone (323) 233-3100

Other practice location 1

2801 S San Pedro St
Los Angeles, CA 90011-2023
Phone (323) 233-3100

Other identifiers 1

IdentifierTypeStateIssuer
A92965OtherCALICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071116000620 CA Practitioner - Family Practice 5597853010 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Stanford University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1919 S San Pedro St
Los Angeles, CA 90011-1121
Phone (323) 233-3100

2098 S Central Ave
Los Angeles, CA 90011-1235
Phone (323) 233-3100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A92965CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Universal Community Health Center CurrentSince Oct 24, 2010 Accepting new patients
Universal Community Health Center Past Accepting new patients
Universal Community Health Center Family Medicine Past Accepting new patients
White Memorial Medical Center Past Accepting new patients

Locations

1919 S San Pedro St
Los Angeles, CA 90011
Phone (323) 233-3100

2801 S San Pedro St
Los Angeles, CA 90011
Phone (323) 233-3100

2098 S Central Ave
Los Angeles, CA 90011
Phone (323) 233-3100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DFGBDA

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Universal Community Health CenterLos Angeles, CA, CCN 551178 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Mar 31, 2010
Mar 31, 2010
Universal Community Health CenterLos Angeles, CA, CCN 921014 Federally qualified health center Corporate Director
W-2 Managing Employee
Operational/Managerial Control		 Jul 16, 2009
Jul 16, 2009
Jul 16, 2009
Universal Community Health CenterLos Angeles, CA, CCN A01032 Federally qualified health center W-2 Managing Employee Mar 31, 2010
Universal Community Health CenterLos Angeles, CA, CCN 921973 Federally qualified health center W-2 Managing Employee Mar 31, 2010
Universal Community Health CenterLos Angeles, CA, CCN A01094 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Mar 31, 2010
Jul 1, 2009
Universal Community Health CenterLos Angeles, CA, CCN A01115 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Mar 31, 2010
Mar 31, 2010
Universal Community Health CenterLos Angeles, CA, CCN A01116 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Mar 31, 2010
Mar 31, 2010

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1023216678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900112023",
            "telephone_number": "323-233-3100",
            "fax_number": "323-233-3124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 E WASHINGTON BLVD STE A",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900213020",
            "telephone_number": "323-233-3100",
            "fax_number": "213-745-3626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2801 S San Pedro St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900112023",
            "country_code": "US",
            "telephone_number": "323-233-3100",
            "fax_number": "323-233-3124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAVEZ",
        "first_name": "EDGAR",
        "middle_name": "ALEXANDER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-05",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A92965",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A92965",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.