NPIMap

Organization Active NPI

Neuromedical Diagnostic Medical Group

  • Neurology Physician
  • Long Beach, CA
National Provider Identifier
1033116546
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
NEUROMEDICAL DIAGNOSTIC MEDICAL GROUP
Practice address
1045 Atlantic Ave
719
Long Beach, CA 90813-3412
Phone
(562) 591-1324
Fax
(562) 437-1054
NPI assigned
Jun 30, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
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

Authorized official

Name
Panos Z Marmarelis, M.D.NPI 1275585622
Title
Partner
Phone
(562) 591-1324

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
Neurology Physician 2084N0400X CA Primary

Addresses

Primary practice location

1045 Atlantic Ave
719
Long Beach, CA 90813-3412

Mailing address

1045 Atlantic Ave
719
Long Beach, CA 90813-3412
Phone (562) 591-1324

Other identifiers 3

IdentifierTypeStateIssuer
W6126OtherCAPTAN PROVIDER IDENTIFIER, MEDICARE
GR0004090MedicaidCA
CP2733OtherCARAIL ROAD MEDICARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040831001597 CA Part B Supplier - Clinic/Group Practice 4284609330 Receives reassigned benefits from 6 practitioners
Practice locations: Long Beach, CA

National Provider Directory

National Provider Directory

Locations

18111 Brookhurst St
#6200
Fountain Valley, CA 92708
Phone (714) 378-5516

1045 Atlantic Ave
Ste 719
Long Beach, CA 90813
Phone (562) 591-1132

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 & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1033116546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 ATLANTIC AVE",
            "address_2": "719",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133412",
            "telephone_number": "562-591-1324",
            "fax_number": "562-437-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 ATLANTIC AVE",
            "address_2": "719",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133412",
            "telephone_number": "562-591-1324",
            "fax_number": "562-437-1054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEUROMEDICAL DIAGNOSTIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "MARMARELIS",
        "authorized_official_first_name": "PANOS",
        "authorized_official_middle_name": "Z",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "562-591-1324",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PTAN PROVIDER IDENTIFIER, MEDICARE",
            "identifier": "W6126",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0004090",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "CP2733",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.