Beverly Hills Executive Medical Group, Inc.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

A85541 Issued in CA

Legal business name

BEVERLY HILLS EXECUTIVE MEDICAL GROUP, INC.

Doing business as

BHCMG Executive ER

Practice address

8530 Wilshire Blvd
Suite 250
Beverly Hills, CA 90211-3122

Phone

(310) 657-0366

Fax

(310) 657-0466

NPI assigned

Jan 14, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Daniel Jacobsen, DC

Title

President

Phone

(310) 657-0366

Specialties & licenses 2

Addresses

Other names 1

• BHCMG Executive ER Doing business as

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

{
    "created_epoch": "1263427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263427200000",
    "number": "1053642009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8530 WILSHIRE BLVD",
            "address_2": "SUITE 250",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902113122",
            "telephone_number": "310-657-0366",
            "fax_number": "310-657-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8530 WILSHIRE BLVD",
            "address_2": "SUITE 250",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902113122",
            "telephone_number": "310-657-0366",
            "fax_number": "310-657-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY HILLS EXECUTIVE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-14",
        "last_updated": "2010-01-14",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-657-0366",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "A85541",
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "CA",
            "license": "DC15646",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BHCMG Executive ER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Multi-Specialty Clinic/Center in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; 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.