Active NPI
Ca Physician Assistant Cooperative Healthcare, PC
- Physician Assistant
- Inglewood, CA
National Provider Identifier
1053145698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Legal business name
- CA PHYSICIAN ASSISTANT COOPERATIVE HEALTHCARE, PC
- Practice address
- 645 Aerick St Ste 3
Inglewood, CA 90301-4884 - Phone
- (310) 431-4926
- NPI assigned
- Aug 27, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark Ashby, PA
- Title
- President/Owner
- Phone
- (818) 968-4242
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
645 Aerick St Ste 3
Inglewood, CA 90301-4884
Mailing address
645 Aerick St Ste 3
Inglewood, CA 90301-4884
Phone (310) 431-4926
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241010001167 | CA | Part B Supplier - Clinic/Group Practice | 9032641469 |
Receives reassigned benefits from 4 practitioners Practice locations: Inglewood, CA |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 5
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Huntington Park, CA
- NPI 1346802840
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724716800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1724716800000",
"number": "1053145698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "645 AERICK ST STE 3",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903014884",
"telephone_number": "310-431-4926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "645 AERICK ST STE 3",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903014884",
"telephone_number": "310-431-4926"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CA PHYSICIAN ASSISTANT COOPERATIVE HEALTHCARE, PC",
"organizational_subpart": "NO",
"enumeration_date": "2024-08-27",
"last_updated": "2024-08-27",
"certification_date": "2024-08-27",
"status": "A",
"authorized_official_last_name": "ASHBY",
"authorized_official_first_name": "MARK",
"authorized_official_title_or_position": "PRESIDENT/OWNER",
"authorized_official_telephone_number": "818-968-4242",
"authorized_official_credential": "PA"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Inglewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2024; 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.