Mary Jo Ford MD Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

G73858 Issued in CA

Legal business name

MARY JO FORD MD INC

Doing business as

Phoenix Pain Medicine

Practice address

555 Pier Avenue
Suite 1
Hermosa Beach, CA 90254-3800

Phone

(310) 374-4100

Fax

(310) 374-4111

NPI assigned

Nov 28, 2006

Last updated

May 29, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Jo Ford, MDNPI 1700951142

Title

President

Phone

(310) 374-4100

Specialties & licenses 1

Addresses

Other names 1

• Phoenix Pain Medicine Doing business as

Locations

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 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.

• Mary Jo Ford, MD

  • Specialist
  • Hermosa Beach, CA
  • NPI 1700951142
  Authorized official Same address or phone

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369785600000",
    "number": "1124194576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 PIER AVENUE",
            "address_2": "SUITE 1",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902543800",
            "telephone_number": "310-374-4100",
            "fax_number": "310-374-4111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 PIER AVENUE",
            "address_2": "SUITE 1",
            "city": "HERMOSA BEACH",
            "state": "CA",
            "postal_code": "902543800",
            "telephone_number": "310-374-4100",
            "fax_number": "310-374-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY JO FORD MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2013-05-29",
        "status": "A",
        "authorized_official_last_name": "FORD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-374-4100",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G73858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phoenix Pain Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexis Ashley Maron, RDT, BCT
• Jenna Raquel Marshall
• Martha B. Koo, M.D., LTD.
• Kimberly Martins, M.A.
• Elizabeth H Marushin, MFT
• Steven Richard Mason, PSY.D. PSYCHOLOGIST
• Julie Matheney, MS, CCC-SLP, CLEC
• Melissa McKay, M.ED., BCBA
• Rebecca McKeen
• Madison McKinley

• Specialist in Hermosa Beach, CA
• Providers in Hermosa Beach, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2013; 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.