NPIMap

Organization Active NPI

Mendrix Medical Associates Inc

  • Psychiatry Physician
  • Gardena, CA
National Provider Identifier
1104657642
Registry record updated Apr 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
MENDRIX MEDICAL ASSOCIATES INC
Practice address
18726 S Western Ave Ste 320
Gardena, CA 90248-3812
Phone
(310) 773-8975
Fax
(702) 977-1496
NPI assigned
Aug 7, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2025

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

Authorized official

Name
Kacey Callison
Title
Authorized Official
Phone
(918) 237-1281

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X

Addresses

Primary practice location

18726 S Western Ave Ste 320
Gardena, CA 90248-3812

Mailing address

8601 Lincoln Blvd # 180-567
Los Angeles, CA 90045-3554

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241112001333 CA Part B Supplier - Clinic/Group Practice 2769916816 Receives reassigned benefits from 9 practitioners
Practice locations: Gardena, CA; Santa Monica, CA; Reseda, CA; Panorama City, CA; North Hills, CA; Long Beach, CA

National Provider Directory

National Provider Directory

Locations

8601 Lincoln Blvd
Ste 108567
Los Angeles, CA 90045

8601 Lincoln Blvd
#180567
Los Angeles, CA 90045

Practitioners & affiliated clinicians

Practitioners 9

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": "1722988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1104657642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8601 LINCOLN BLVD # 180-567",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900453554",
            "fax_number": "702-977-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18726 S WESTERN AVE STE 320",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902483812",
            "telephone_number": "310-773-8975",
            "fax_number": "702-977-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDRIX MEDICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-07",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "CALLISON",
        "authorized_official_first_name": "KACEY",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "918-237-1281"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gardena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; 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.