Individual provider Active NPI

Madisyn Telon

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1114651841
Registry record updated Jun 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA64575 Issued in CA
Practice address
1919 S San Pedro St
Los Angeles, CA 90011-1121
Phone
(323) 233-3100
NPI assigned
Jul 9, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X PA64575 CA Primary

Addresses

Primary practice location

1919 S San Pedro St
Los Angeles, CA 90011-1121

Mailing address

1919 S San Pedro St
Los Angeles, CA 90011-1121

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240924003587 CA Practitioner - Physician Assistant 0345781829 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
64575CAMDMassage Therapist
PA64575CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Universal Community Health Center CurrentSince Aug 14, 2024 Accepting new patients
Universal Community Health Center CurrentSince Aug 14, 2024 Accepting new patients

Locations

1919 S San Pedro St
Los Angeles, CA 90011
Phone (323) 233-3100

1005 E Washington Blvd
Los Angeles, CA 90021
Phone (213) 745-3636

2801 S San Pedro St
Los Angeles, CA 90011
Phone (323) 233-3100

2098 S Central Ave
Los Angeles, CA 90011
Phone (323) 233-3100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DFGBDA

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1657324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718668800000",
    "number": "1114651841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900111121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900111121",
            "telephone_number": "323-233-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TELON",
        "first_name": "MADISYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-09",
        "last_updated": "2024-06-18",
        "certification_date": "2024-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA64575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.