Active NPI
Matthew Olufemi Egbedi
- Case Manager/Care Coordinator
- Lynwood, CA
National Provider Identifier
1053666289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 2620 Industry Way
Lynwood, CA 90262-4024 - Phone
- (310) 667-4070
- NPI assigned
- Jul 13, 2012
- Last updated
- Nov 19, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | |||
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
2620 Industry Way
Lynwood, CA 90262-4024
Mailing address
2620 Industry Way
Lynwood, CA 90262-4024
Phone (310) 667-4070
Other practice location 1
7410 S Broadway
Los Angeles, CA 90003-2034
Phone (323) 541-9019
Other practice location 2
2620 Industry Way
Lynwood, CA 90262-4024
Phone (310) 667-4070
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)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern California Health & Rehabilitation Program | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Lynwood, CA
- NPI 1467775221
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1342137600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605744000000",
"number": "1053666289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2620 INDUSTRY WAY",
"city": "LYNWOOD",
"state": "CA",
"postal_code": "902624024",
"telephone_number": "310-667-4070"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 INDUSTRY WAY",
"city": "LYNWOOD",
"state": "CA",
"postal_code": "902624024",
"telephone_number": "310-667-4070"
}
],
"practiceLocations": [
{
"address_1": "7410 S Broadway",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900032034",
"country_code": "US",
"telephone_number": "323-541-9019",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2620 Industry Way",
"address_purpose": "LOCATION",
"city": "Lynwood",
"state": "CA",
"postal_code": "902624024",
"country_code": "US",
"telephone_number": "310-667-4070",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "OLUFEMI EGBEDI",
"first_name": "MATTHEW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-07-13",
"last_updated": "2020-11-19",
"certification_date": "2020-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lynwood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.