Active NPI
Jerome Pittman, M.D.,
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1114013737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- G47112
- Practice address
- 8635 W 3Rd Street
Ste 1180 W
Los Angeles, CA 90048 - Phone
- (323) 633-5830
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | G47112 | CA | Primary |
Addresses
Primary practice location
8635 W 3Rd Street
Ste 1180 W
Los Angeles, CA 90048
Mailing address
6709, La Tijera Blvd
Ste# 923
Los Angeles, CA 90045
Phone (323) 633-5830
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G47112 | Other | CA | STATE LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G47112 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Circumcision Specialist, Inc | Current | Accepting new patients |
Organizations & group practices 1
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114013737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6709, LA TIJERA BLVD",
"address_2": "STE# 923",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90045",
"telephone_number": "323-633-5830"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8635 W 3RD STREET",
"address_2": "STE 1180 W",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90048",
"telephone_number": "323-633-5830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PITTMAN",
"first_name": "JEROME",
"name_prefix": "Dr.",
"credential": "M.D.,",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "G47112",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "G47112",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.