Prairie Medical Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

058963 Issued in CA

Legal business name

PRAIRIE MEDICAL GROUP INC

Practice address

10100 Culver Blvd
Culver City, CA 90231

Phone

(310) 280-2700

Fax

(310) 837-7334

NPI assigned

Jan 29, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Christopher C Chidi, MD

Title

President

Phone

(310) 214-8677

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043356272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT NO 2834",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90084",
            "telephone_number": "310-214-8677",
            "fax_number": "310-921-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 CULVER BLVD",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "90231",
            "telephone_number": "310-280-2700",
            "fax_number": "310-837-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHIDI",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-214-8677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "058963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0078673",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Lin Pow-Anpongkul, LCSW
• Teryn Powell
• Charlotte Pradie
• Celina Prado
• Geddy Amilcar Prado
• Margaret Pranchenko
• Prashant Prasad
• Praveen Gupta a Medical Corporation
• Jocelyn Precencion, LVN
• Lesly Yamel Preciado

• Specialist in Culver City, CA
• Providers in Culver City, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.