NPIMap

Organization Active NPI

Eagan Concierge Medical Group, Inc

  • Psychiatry Physician
  • Los Angeles, CA
National Provider Identifier
1083296446
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
EAGAN CONCIERGE MEDICAL GROUP, INC
Practice address
2658 Griffith Park Blvd Ste 305
Los Angeles, CA 90039-2520
Phone
(310) 702-9803
NPI assigned
Apr 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Authorized official

Name
Breanna Splain
Title
Director of Credentialing
Phone
(760) 835-6880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X Primary

Addresses

Primary practice location

2658 Griffith Park Blvd Ste 305
Los Angeles, CA 90039-2520

Mailing address

2658 Griffith Park Blvd Ste 305
Los Angeles, CA 90039-2520

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619395200000",
    "number": "1083296446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2658 GRIFFITH PARK BLVD STE 305",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900392520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2658 GRIFFITH PARK BLVD STE 305",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900392520",
            "telephone_number": "310-702-9803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAGAN CONCIERGE MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-04-26",
        "certification_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "SPLAIN",
        "authorized_official_first_name": "BREANNA",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "760-835-6880"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; 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.