Active NPI
La Vascular Access Ctr Medical GRP
- Specialist
- Inglewood, CA
National Provider Identifier
1104960558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Legal business name
- LA VASCULAR ACCESS CTR MEDICAL GRP
- Practice address
- 323 N Prairie Ave
Suite 114
Inglewood, CA 90301-4502 - Phone
- (310) 674-9300
- Fax
- (310) 674-9301
- NPI assigned
- Feb 19, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jack E Rubin, MD
- Title
- Authorized Offical
- Phone
- (310) 674-9300
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
323 N Prairie Ave
Suite 114
Inglewood, CA 90301-4502
Mailing address
323 N Prairie Ave
Suite 114
Inglewood, CA 90301-4502
Phone (310) 674-9300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0105550 | Other | CA | MEDI-CAL - GROUP |
| W21161 | Other | CA | MEDICARE - GROUP |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071025000522 | CA | Part B Supplier - Clinic/Group Practice | 0749377554 |
Receives reassigned benefits from 7 practitioners Practice locations: Inglewood, CA |
National Provider Directory
National Provider DirectoryLocations
1801 W Olympic Blvd
#1
Pasadena, CA 91199
1801 W Olympic Blvd
#1087
Pasadena, CA 91199
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Vascular & Interventional Radiology Physician
- Los Alamitos, CA
- NPI 1720390420
CA
-
- Vascular & Interventional Radiology Physician
- Northridge, CA
- NPI 1043471022
CA
-
- Diagnostic Radiology Physician
- Glendale, CA
- NPI 1477755635
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171843200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1634169600000",
"number": "1104960558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "323 N PRAIRIE AVE",
"address_2": "SUITE 114",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903014502",
"telephone_number": "310-674-9300",
"fax_number": "310-674-9301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "323 N PRAIRIE AVE",
"address_2": "SUITE 114",
"city": "INGLEWOOD",
"state": "CA",
"postal_code": "903014502",
"telephone_number": "310-674-9300",
"fax_number": "310-674-9301"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LA VASCULAR ACCESS CTR MEDICAL GRP",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-19",
"last_updated": "2021-10-14",
"certification_date": "2021-10-14",
"status": "A",
"authorized_official_last_name": "RUBIN",
"authorized_official_first_name": "JACK",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "AUTHORIZED OFFICAL",
"authorized_official_telephone_number": "310-674-9300",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL - GROUP",
"identifier": "GR0105550",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE - GROUP",
"identifier": "W21161",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Inglewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2021; 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.