NPIMap

Organization Active NPI

Jefferson West Medical Group

  • Primary Care Clinic/Center
  • Culver City, CA
National Provider Identifier
1023275542
Registry record updated May 21, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
A35973 Issued in CA
Legal business name
JEFFERSON WEST MEDICAL GROUP
Practice address
4212 Overland Ave
Culver City, CA 90230-3736
Phone
(310) 204-2574
Fax
(310) 204-2820
NPI assigned
May 21, 2008
Last updated
May 21, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2008

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

Authorized official

Name
Dr. Barbara Donahue, M.D.
Title
President
Phone
(310) 204-2574

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X A35973 CA Primary

Addresses

Primary practice location

4212 Overland Ave
Culver City, CA 90230-3736

Mailing address

4212 Overland Ave
Culver City, CA 90230-3736
Phone (310) 204-2574

National Provider Directory

National Provider Directory

Locations

4212 Overland Ave
Culver City, CA 90230
Phone (310) 204-2574

NPI Registry JSON

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

{
    "created_epoch": "1211328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211328000000",
    "number": "1023275542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 OVERLAND AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902303736",
            "telephone_number": "310-204-2574",
            "fax_number": "310-204-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 OVERLAND AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902303736",
            "telephone_number": "310-204-2574",
            "fax_number": "310-204-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON WEST MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-21",
        "last_updated": "2008-05-21",
        "status": "A",
        "authorized_official_last_name": "DONAHUE",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-204-2574",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A35973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.