NPIMap

Organization Active NPI

Far West Podiatric Medical Group

  • Foot Surgery Podiatrist
  • Hawthorne, CA
National Provider Identifier
1124175740
Registry record updated Jul 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot Surgery PodiatristTaxonomy code 213ES0131X
License
E3328 Issued in CA
Legal business name
FAR WEST PODIATRIC MEDICAL GROUP
Practice address
13624 Hawthorne Blvd Ste 206
Hawthorne, CA 90250-5818
Phone
(310) 675-0900
Fax
(310) 675-0904
NPI assigned
Jan 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2022

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

Authorized official

Name
Dr. Karen L Wrubel, DPMNPI 1982654307
Title
President
Phone
(310) 675-0900

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
Foot Surgery PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213ES0131X E3328 CA Primary

Addresses

Primary practice location

13624 Hawthorne Blvd Ste 206
Hawthorne, CA 90250-5818

Mailing address

13624 Hawthorne Blvd
Suite 206
Hawthorne, CA 90250-5818
Phone (310) 675-0900

Other identifiers 1

IdentifierTypeStateIssuer
GRE001780MedicaidCA

Other names 1

  • Far West Podiatry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322001781 CA Part B Supplier - Clinic/Group Practice 0840181681 Receives reassigned benefits from 4 practitioners
Practice locations: Hawthorne, CA
O20220810003017 CA Part B Supplier - Clinic/Group Practice 5799168654 Receives reassigned benefits from 3 practitioners
Practice locations: Hawthorne, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

13624 Hawthorne Blvd
Hawthorne, CA 90250

13624 Hawthorne Blvd
Ste 206
Hawthorne, CA 90250
Phone (310) 675-0900

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657670400000",
    "number": "1124175740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13624 HAWTHORNE BLVD",
            "address_2": "SUITE 206",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505818",
            "telephone_number": "310-675-0900",
            "fax_number": "310-675-0904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13624 HAWTHORNE BLVD STE 206",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902505818",
            "telephone_number": "310-675-0900",
            "fax_number": "310-675-0904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAR WEST PODIATRIC MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A",
        "authorized_official_last_name": "WRUBEL",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-675-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213ES0131X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot Surgery",
            "state": "CA",
            "license": "E3328",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GRE001780",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Far West Podiatry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Far West Podiatry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hawthorne, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; 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.