NPIMap

Organization Active NPI

Lebreoot a Professional Medical Corporation

  • Wound Care Registered Nurse
  • Beverly Hills, CA
National Provider Identifier
1083306773
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Wound Care Registered NurseTaxonomy code 163WW0000X
Legal business name
LEBREOOT A PROFESSIONAL MEDICAL CORPORATION
Practice address
9171 Wilshire Blvd Ste 500
Beverly Hills, CA 90210-5536
Phone
(310) 331-0077
Fax
(213) 582-8811
NPI assigned
May 22, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Joobin A Shemtov
Title
Ceo
Phone
(310) 999-7098

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X Primary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QG0300X

Addresses

Primary practice location

9171 Wilshire Blvd Ste 500
Beverly Hills, CA 90210-5536

Mailing address

9171 Wilshire Blvd Ste 500
Beverly Hills, CA 90210-5536
Phone (310) 331-0077

Other practice location 1

255 S King St Ste 800
Seattle, WA 98104-3318
Phone (310) 331-0077

Other practice location 2

830 NE Holladay St
Portland, OR 97232-2104
Phone (310) 331-0077

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WA, OR, NC4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20230912002701 CA Part B Supplier - Clinic/Group Practice 4981068756 Receives reassigned benefits from 6 practitioners
Practice locations: Beverly Hills, CA
O20231127003318 WA Part B Supplier - Clinic/Group Practice 4981068756 Receives reassigned benefits from 5 practitioners
Practice locations: Battle Ground, WA; Camas, WA; Vancouver, WA
O20240918001933 OR Part B Supplier - Clinic/Group Practice 4981068756 Receives reassigned benefits from 2 practitioners
Practice locations: Portland, OR
O20241206001314 NC Part B Supplier - Clinic/Group Practice 4981068756 Receives reassigned benefits from 1 practitioner
Practice locations: Raleigh, NC

National Provider Directory

National Provider Directory

Locations

9171 Wilshire Blvd
Ste 516
Beverly Hills, CA 90210

9171 Wilshire Blvd
Ste 526
Beverly Hills, CA 90210
Phone (310) 331-0058

255 S King St
Ste 800
Seattle, WA 98104
Phone (206) 338-5592

Practitioners & affiliated clinicians

Practitioners 12

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": "1684713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1083306773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9171 WILSHIRE BLVD STE 500",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105536",
            "telephone_number": "310-331-0077",
            "fax_number": "213-582-8811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9171 WILSHIRE BLVD STE 500",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902105536",
            "telephone_number": "310-331-0077",
            "fax_number": "213-582-8811"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "255 S King St Ste 800",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981043318",
            "country_code": "US",
            "telephone_number": "310-331-0077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "830 NE Holladay St",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972322104",
            "country_code": "US",
            "telephone_number": "310-331-0077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEBREOOT A PROFESSIONAL MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-22",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "SHEMTOV",
        "authorized_official_first_name": "JOOBIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "310-999-7098"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 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.

Verify at the official NPI Registry.