Active NPI
Michael Clark Graves, MD
- Neurology Physician
- Los Angeles, CA
National Provider Identifier
1033134564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- G21341
- Practice address
- 300 Medical Plaza
#B200
Los Angeles, CA 90095-0001 - Phone
- (310) 794-1195
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | G21341 | CA | Primary |
Addresses
Primary practice location
300 Medical Plaza
#B200
Los Angeles, CA 90095-0001
Mailing address
5767 W Century Blvd
Suite 10
Los Angeles, CA 90045-5631
Phone (310) 301-7941
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G213410 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21341 | CA | MD | Nutrition Chiropractor |
| G21341 | CA | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jules Stein Eye Institute Medical Group | Current | Accepting new patients | |
| UCLA Medical Group | Neurology | Past | Accepting new patients |
Locations
File 2939
Los Angeles, CA 90074
Phone (310) 794-6596
300 UCLA Medical Plz
Ste B200
Los Angeles, CA 90095
Phone (310) 405-9824
Organizations & group practices 2
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.
-
- Ophthalmology Physician
- Los Angeles, CA
- NPI 1326006966
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348790400000",
"number": "1033134564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5767 W CENTURY BLVD",
"address_2": "SUITE 10",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900455631",
"telephone_number": "310-301-7941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 MEDICAL PLAZA",
"address_2": "#B200",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900950001",
"telephone_number": "310-794-1195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAVES",
"first_name": "MICHAEL",
"middle_name": "CLARK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2012-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "CA",
"license": "G21341",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G213410",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.