NPIMap

Organization Active NPI

Gage Medical Clinic Inc

Doing business as Pacoima Medical Center

  • Family Medicine Physician
  • Pacoima, CA
National Provider Identifier
1114053279
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A47748 Issued in CA
Legal business name
GAGE MEDICAL CLINIC INC
Doing business as
Pacoima Medical Center
Practice address
13563 Van Nuys Blvd
Pacoima, CA 91331-3029
Phone
(818) 890-5300
Fax
(818) 890-0880
NPI assigned
Feb 25, 2007
Last updated
Feb 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

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

Authorized official

Name
Odilia Walsh, ADMINISTRATOR
Title
Administrator
Phone
(562) 706-2433

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Family Medicine Physician 207Q00000X G29047 CA
Family Medicine Physician 207Q00000X A47748 CA Primary
Obstetrics & Gynecology Physician 207V00000X A67946 CA

Addresses

Primary practice location

13563 Van Nuys Blvd
Pacoima, CA 91331-3029

Mailing address

13563 Van Nuys Blvd
Pacoima, CA 91331-3029
Phone (818) 890-5300

Other names 1

  • PACOIMA MEDICAL CENTER Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Gage Medical Clinic Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1172361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707436800000",
    "number": "1114053279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13563 VAN NUYS BLVD",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913313029",
            "telephone_number": "818-890-5300",
            "fax_number": "818-890-0880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13563 VAN NUYS BLVD",
            "city": "PACOIMA",
            "state": "CA",
            "postal_code": "913313029",
            "telephone_number": "818-890-5300",
            "fax_number": "818-890-0880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAGE MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-25",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "WALSH",
        "authorized_official_first_name": "ODILIA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "562-706-2433",
        "authorized_official_credential": "ADMINISTRATOR"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G29047",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A47748",
            "primary": true
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A67946",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PACOIMA MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pacoima, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.