Concentra

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

A119899 Issued in CA

Legal business name

CONCENTRA

Practice address

4306 Duquesne Ave
Culver City, CA 90232-2957

Phone

(410) 608-7988

NPI assigned

May 3, 2014

Organization subpart

No

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

Authorized official

Name

Jill Davis

Title

Credentialing Support Specialist

Phone

(972) 364-8083

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1399075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399075200000",
    "number": "1083024723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4306 DUQUESNE AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322957",
            "telephone_number": "410-608-7988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4306 DUQUESNE AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322957",
            "telephone_number": "410-608-7988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONCENTRA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-03",
        "last_updated": "2014-05-03",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "CREDENTIALING SUPPORT SPECIALIST",
        "authorized_official_telephone_number": "972-364-8083"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A119899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Elite Transportation Inc
• Companion Hospice and Palliative Care Services, LLC
• Complete Care Community Health Center, Inc (Complete Care Community Health Center - Culver City)
• Rachel Kathleen Compton
• Tanya Compton
• Carmen Condon
• Vanessa Whitmore Conlon
• Julie Steres Connella, MFT
• Megan Conner
• Dustin Conrad

• Physical Medicine & Rehabilitation Physician in Culver City, CA
• Providers in Culver City, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2014; 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.