NPIMap

Organization Active NPI

L a County Nephrology Associates a Medical Corporation

  • Specialist
  • Montebello, CA
National Provider Identifier
1083649651
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
L A COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION
Practice address
3114 W Beverly Blvd
Montebello, CA 90640-2217
Phone
(323) 726-1317
Fax
(323) 726-3870
NPI assigned
Jul 12, 2006
Last updated
Jun 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Authorized official

Name
Ms. Sandy Marino
Title
Office Manager
Phone
(323) 726-3868

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

3114 W Beverly Blvd
Montebello, CA 90640-2217

Mailing address

PO Box 22036
Belfast, ME 04915-4117
Phone (323) 726-3868

Other identifiers 6

IdentifierTypeStateIssuer
GR0052991MedicaidCA
00A792790MedicaidCA
C13392OtherCARAILROAD MEDICARE GROUP
GR0052992MedicaidCA
ZZZ447842OtherCABLUE SHIELD GROUP NUMBER
GR0052990MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050607000178 CA Part B Supplier - Clinic/Group Practice 3173566536 Receives reassigned benefits from 13 practitioners
Practice locations: Montebello, CA

National Provider Directory

National Provider Directory

Locations

5714 E Olympic Blvd
Commerce, CA 90022
Phone (323) 887-0841

3521 Whittier Blvd
Los Angeles, CA 90023
Phone (323) 263-9541

3106 W Beverly Blvd
Montebello, CA 90640
Phone (323) 726-3868

10012 Norwalk Blvd
Ste 190
Santa Fe Springs, CA 90670
Phone (562) 699-0527

1701 Santa Anita Ave
South El Monte, CA 91733
Phone (626) 350-7916

1938 Tyler Ave
Ste J
South El Monte, CA 91733
Phone (626) 350-6692

2841 Lomita Blvd
Torrance, CA 90505
Phone (310) 257-0508

Practitioners & affiliated clinicians

Practitioners 19

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.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719360000000",
    "number": "1083649651",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 22036",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049154117",
            "telephone_number": "323-726-3868",
            "fax_number": "323-726-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3114 W BEVERLY BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906402217",
            "telephone_number": "323-726-1317",
            "fax_number": "323-726-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "L A COUNTY NEPHROLOGY ASSOCIATES A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A",
        "authorized_official_last_name": "MARINO",
        "authorized_official_first_name": "SANDY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "323-726-3868",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0052991",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A792790",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE GROUP",
            "identifier": "C13392",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0052992",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "ZZZ447842",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0052990",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montebello, CA

Sources for this page

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