NPIMap

Organization Active NPI

Southern California Permanente Medical Group

  • Clinical Medical Laboratory
  • Los Angeles, CA
National Provider Identifier
1124269717
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice address
4580 Electronics PL
Los Angeles, CA 90039-1008
Phone
(818) 502-5141
NPI assigned
Mar 12, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Authorized official

Name
Dr. Ramin Davidoff, M.D.
Title
Executive Medical Director
Phone
(877) 608-0044

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

4580 Electronics PL
Los Angeles, CA 90039-1008

Mailing address

393 E Walnut St
3Rd Floor PHR Group & Provider Enrollment
Pasadena, CA 91188-0001
Phone (626) 405-7914

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091119000150 CA Part B Supplier - Independent Clinical Laboratory 6002729175 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chino Hills, CA; Los Angeles, CA; North Hollywood, CA

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Southern California Permanente Medical Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1236816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1124269717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "address_2": "3RD FLOOR PHR GROUP & PROVIDER ENROLLMENT",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880001",
            "telephone_number": "626-405-7914",
            "fax_number": "626-405-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4580 ELECTRONICS PL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900391008",
            "telephone_number": "818-502-5141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-12",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "DAVIDOFF",
        "authorized_official_first_name": "RAMIN",
        "authorized_official_title_or_position": "EXECUTIVE MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "877-608-0044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4580 Electronics Pl",
            "city": "LOS ANGELES",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900391008",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; 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.