NPIMap

Organization Active NPI

Morningside Primary Care Medical Ctr, Inc

  • General Practice Physician
  • Los Angeles, CA
National Provider Identifier
1083643837
Registry record updated Dec 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MORNINGSIDE PRIMARY CARE MEDICAL CTR, INC
Practice address
1704 W Manchester Ave
Suite 101
Los Angeles, CA 90047-3034
Phone
(323) 778-6215
Fax
(323) 778-6312
NPI assigned
Jul 2, 2006
Last updated
Dec 17, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2014

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

Authorized official

Name
Mr. Lemmon C McMillan, M.D.
Title
President
Phone
(323) 778-6215

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary

Addresses

Primary practice location

1704 W Manchester Ave
Suite 101
Los Angeles, CA 90047-3034

Mailing address

1704 W Manchester Ave
Suite 101
Los Angeles, CA 90047-3034
Phone (323) 778-6215

Other identifiers 1

IdentifierTypeStateIssuer
GR0059700MedicaidCA

National Provider Directory

National Provider Directory

Locations

1704 W Manchester Ave
Ste 101
Los Angeles, CA 90047
Phone (323) 778-6215

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1151798400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418774400000",
    "number": "1083643837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1704 W MANCHESTER AVE",
            "address_2": "SUITE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900473034",
            "telephone_number": "323-778-6215",
            "fax_number": "323-778-6312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 W MANCHESTER AVE",
            "address_2": "SUITE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900473034",
            "telephone_number": "323-778-6215",
            "fax_number": "323-778-6312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MORNINGSIDE PRIMARY CARE MEDICAL CTR, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-02",
        "last_updated": "2014-12-17",
        "status": "A",
        "authorized_official_last_name": "MCMILLAN",
        "authorized_official_first_name": "LEMMON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-778-6215",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0059700",
            "state": "CA"
        }
    ],
    "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 Dec 17, 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.