Southern California Permanente Medical Group
Organization Active NPI Health Maintenance Organization · Los Angeles, CA
NPI 1043242563 · NPPES record last updated Nov 2, 2021
Key facts
- NPI
- 1043242563
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Maintenance Organization 302R00000X
- Legal business name
- SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
- Practice address
- 6041 Cadillac Ave
Los Angeles, CA 90034-1702 - Phone
- (323) 857-2000
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Ramin Davidoff, MD
- Title
- Executive Medical Director
- Phone
- (877) 608-0044
Other NPIs on the same Medicare enrollment 24
Practitioners 1,024
-
Lauren Abbas, MD
-
Tara Abrams, NP
-
Joseph Abu-Dalu, MD
-
Marcela Acuna, NP
-
Alipasha Adrangui, M.D.
-
Angeli O. Agatep, MD
-
Roxana Aghili, DO
-
Jennifer Aguayo, MD
-
Jose Julio Aguinada, DPT
-
Olivia L Aguirre, MFT
-
Tina Ahmed, LCSW
-
Shreya Aiyar, MD
-
Ani Akopyan, PA-C
-
Noor S Al-Hassan, OD
-
Kathia G Albanez, OD
-
Marlene Alfaro, MD
-
Jordan Arielle Allen, PA-C
-
Robert Waldo Allen, M.D.
-
Eve Allerton, PA
-
Hasan Almohsen, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000678 | CA | Part B Supplier - Clinic/Group Practice | 6002729175 |
Receives reassigned benefits from 14,591 practitioners 21 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
| O20260217001864 | CA | MDPP Supplier - in-Person MDPP Supplier With Distance Learning | 6002729175 |
12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
3955 Bonita Rd
Bonita, CA 91902
Phone (619) 409-6404
5105 W Goldleaf Cir
Los Angeles, CA 90056
Phone (323) 298-3100
1550 W Manchester Ave
Los Angeles, CA 90047
Phone (323) 565-3000
1505 N Edgemont St
Los Angeles, CA 90027
Phone (323) 783-1770
9455 Clairemont Mesa Blvd
San Diego, CA 92123
Phone (858) 266-4200
3420 Kenyon St
San Diego, CA 92110
Phone (619) 221-6550
3900 Alamo St
Simi Valley, CA 93063
Phone (805) 582-3004
780 Shadowridge Dr
Vista, CA 92083
Phone (760) 599-2350
21263 Erwin St
Woodland Hls, CA 91367
Phone (818) 592-3028
22550 Savi Ranch Pkwy
Yorba Linda, CA 92887
Phone (714) 685-3500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | Yes |
Addresses
Primary practice location
6041 Cadillac Ave
Los Angeles, CA 90034-1702
Mailing address
393 E Walnut St
3Rd FL PHR Group & Provider Enrollment
Pasadena, CA 91188-0001
Phone (626) 405-7914
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ77244Z | Medicaid | CA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) |
Other providers in Los Angeles, CA
- Southern California Heart and Vascular Center
- Southern California Heart Centers Inc
- Southern California Medical Gastroenterology Group, Inc
- Southern California Medical Group
- Southern California Permanente Medical Group
- Southern California Permanente Medical Group
- Southern California Permanente Medical Group
- Southern California Permanente Medical Group
- Southern California Physicians Alliance Inc
- Southern California Podiatry Institute, Inc.
All providers in Los Angeles, CA · Health Maintenance Organization in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 2, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.