Individual provider Active NPI

Jimmy K Liao, M.D.

  • Internal Medicine Physician
  • Fullerton, CA
National Provider Identifier
1104965383
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A66300 Issued in CA
Practice address
2557 Pearblossom St
Fullerton, CA 92835-4407
Phone
(310) 403-2677
NPI assigned
Feb 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2007

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A66300 CA Primary
General Acute Care Hospital 282N00000X A66300 CA

Addresses

Primary practice location

2557 Pearblossom St
Fullerton, CA 92835-4407

Mailing address

2557 Pearblossom St
Fullerton, CA 92835-4407
Phone (310) 403-2677

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
I20060210000407 CA Practitioner - Internal Medicine 3870508989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Texas Medical School at Houston, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pih Health PhysiciansGroup PAC ID 8426951328, 616 clinicians

Practice addresses (Care Compare)

11500 Brookshire Ave
Downey, CA 90241-4917
Phone (562) 904-5000

12401 Washington Blvd
Whittier, CA 90602-1006
Phone (562) 698-0811

12675 La Mirada Blvd
Suite 201And401
La Mirada, CA 90638-2200
Phone (562) 903-7339

15725 Whittier Blvd
Whittier, CA 90603-2347
Phone (562) 947-1669

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
78.61 of 100Reported as group
Quality
58.7
Improvement activities
40
Cost
75.08

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
66300CAMDPharmacist
A66300CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bright Health Physicians of Pih CurrentSince Jul 1, 2008 Accepting new patients
Pih Health Physicians Current Accepting new patients
Pih Health Physicians CurrentSince Jul 1, 2008 Accepting new patients

Locations

12675 La Mirada Blvd
Ste 201401
La Mirada, CA 90638
Phone (562) 903-7339

2220 Clark Ave
Long Beach, CA 90815
Phone (562) 597-4181

15725 Whittier Blvd
Whittier, CA 90603
Phone (562) 448-1350

12401 Washington Blvd
Whittier, CA 90602
Phone (562) 698-0611

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 4

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": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193702400000",
    "number": "1104965383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2557 PEARBLOSSOM ST",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354407",
            "telephone_number": "310-403-2677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2557 PEARBLOSSOM ST",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928354407",
            "telephone_number": "310-403-2677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIAO",
        "first_name": "JIMMY",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-05",
        "last_updated": "2007-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A66300",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "CA",
            "license": "A66300",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

Verify at the official NPI Registry.