NPIMap

Organization Active NPI

El Dorado Community Service Center

Doing business as Venice Medical & Mental Health Services

  • Primary Care Clinic/Center
  • Venice, CA
National Provider Identifier
1114096872
Registry record updated Jan 31, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
960001025 Issued in CA
Legal business name
EL DORADO COMMUNITY SERVICE CENTER
Doing business as
Venice Medical & Mental Health Services
Practice address
717 Lincoln Blvd
Venice, CA 90291-2845
Phone
(310) 399-9883
Fax
(310) 399-9678
NPI assigned
Nov 7, 2006
Last updated
Jan 31, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2017

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

Authorized official

Name
Seanjay Ramanand Sharma
Title
Director
Phone
(661) 254-6630

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 960001025 CA Primary

Addresses

Primary practice location

717 Lincoln Blvd
Venice, CA 90291-2845

Mailing address

PO Box 801809
Valencia, CA 91380-1809
Phone (661) 254-6630

Other names 1

  • VENICE MEDICAL & MENTAL HEALTH SERVICES Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050111000696 CA Part B Supplier - Clinic/Group Practice 4183672645 Receives reassigned benefits from 15 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Azusa, CA; Venice, CA; Van Nuys, CA; San Francisco, CA; Palmdale, CA; Newhall, CA; Los Angeles, CA; Lawndale, CA…

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

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": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485820800000",
    "number": "1114096872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 801809",
            "city": "VALENCIA",
            "state": "CA",
            "postal_code": "913801809",
            "telephone_number": "661-254-6630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 LINCOLN BLVD",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912845",
            "telephone_number": "310-399-9883",
            "fax_number": "310-399-9678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL DORADO COMMUNITY SERVICE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2017-01-31",
        "status": "A",
        "authorized_official_last_name": "SHARMA",
        "authorized_official_first_name": "SEANJAY",
        "authorized_official_middle_name": "RAMANAND",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "661-254-6630"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "960001025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VENICE MEDICAL & MENTAL HEALTH SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Venice, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2017; 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.

Verify at the official NPI Registry.