NPIMap

Organization Active NPI

Anaheim Emergency Medical Group

  • Emergency Medicine Physician
  • Anaheim, CA
National Provider Identifier
1114626017
Registry record updated Feb 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ANAHEIM EMERGENCY MEDICAL GROUP
Doing business as
Anaheim Emergency Medical Group
Practice address
1111 W la Palma Ave
Anaheim, CA 92801-2804
Phone
(714) 774-1450
NPI assigned
Feb 28, 2023
Last updated
Feb 28, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2023

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

Authorized official

Name
Dr. Chad L. Clark, MDNPI 1023052545
Title
Managing Director
Phone
(951) 898-0823

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

1111 W la Palma Ave
Anaheim, CA 92801-2804

Mailing address

4401 W Memorial Rd Ste 121
Oklahoma City, OK 73134-1722
Phone (405) 751-4664

Other names 1

  • Anaheim Emergency Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230518003235 CA Part B Supplier - Clinic/Group Practice 9133585029 Receives reassigned benefits from 47 practitioners
Practice locations: Anaheim, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1677542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1114626017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 W MEMORIAL RD STE 121",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341722",
            "telephone_number": "405-751-4664",
            "fax_number": "405-751-3183"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 W LA PALMA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012804",
            "telephone_number": "714-774-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANAHEIM EMERGENCY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-28",
        "last_updated": "2023-02-28",
        "certification_date": "2023-02-28",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CHAD",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "951-898-0823",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anaheim Emergency Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2023; 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.