Individual provider Active NPI

Hartley Cohen, M.D.

  • Gastroenterology Physician
  • Los Angeles, CA
National Provider Identifier
1104826213
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
A31532 Issued in CA
Practice address
637 Lucas Ave Ste 101
Los Angeles, CA 90017-1997
Phone
(213) 977-1010
NPI assigned
Jul 29, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X A31532 CA Primary

Addresses

Primary practice location

637 Lucas Ave Ste 101
Los Angeles, CA 90017-1997

Mailing address

15581 Wild Plum Cir
Huntington Beach, CA 92647-2954
Phone (213) 977-1010

Other practice location 1

1245 Wilshire Blvd
Suite 616
Los Angeles, CA 90017-4810
Phone (213) 977-1225

Other identifiers 3

IdentifierTypeStateIssuer
00A315320MedicaidCA
00A315320OtherCABLUE SHIELD PIN
CB209349OtherCAMEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090323000464 CA Practitioner - GastroenterologyPractitioner - Internal Medicine 5698832491 Reassigns benefits to 1 organization
Practice locations: Los Angeles, CA

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

15581 Wild Plum Cir
Huntington Beach, CA 92647-2954

637 S Lucas Ave
Suite 101
Los Angeles, CA 90017-1997
Phone (213) 977-2280

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy19
Upper gastrointestinal (GI) endoscopy for acid reflux24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A31532CAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Hospital Los Angeles Medical Group, Inc. CurrentSince Nov 5, 2018 Accepting new patients
Usc Internal Medicine, Inc. Gastroenterology Past Accepting new patients
Children'S Hospital Los Angeles Past Accepting new patients

Locations

4650 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 361-2122

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1104826213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15581 WILD PLUM CIR",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926472954",
            "telephone_number": "213-977-1010",
            "fax_number": "213-977-1239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "637 LUCAS AVE STE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900171997",
            "telephone_number": "213-977-1010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1245 Wilshire Blvd",
            "address_2": "SUITE 616",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900174810",
            "country_code": "US",
            "telephone_number": "213-977-1225",
            "fax_number": "213-977-1239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COHEN",
        "first_name": "HARTLEY",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "CA",
            "license": "A31532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A315320",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PIN",
            "identifier": "00A315320",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "CB209349",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.