NPIMap

Organization Active NPI

Breastlink Medical Group Inc

  • Surgery Physician
  • Orange, CA
National Provider Identifier
1124689989
Registry record updated Jun 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
BREASTLINK MEDICAL GROUP INC
Practice address
230 S Main St Ste B-100
Orange, CA 92868-3851
Phone
(714) 541-0101
Fax
(714) 541-0450
NPI assigned
Jun 24, 2019
Last updated
Jun 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2019

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

Authorized official

Name
Howard Gerald BergerNPI 1851479315
Title
President
Phone
(310) 445-2951

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

230 S Main St Ste B-100
Orange, CA 92868-3851

Mailing address

1510 Cotner Ave
Los Angeles, CA 90025-3303

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190911002154 CA Part B Supplier - Clinic/Group Practice 7012956121 Receives reassigned benefits from 4 practitioners
Practice locations: Orange, CA; Newport Beach, CA

National Provider Directory

National Provider Directory

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Locations

1510 Cotner Ave
Los Angeles, CA 90025
Phone (310) 445-2851

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1124689989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1510 COTNER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900253303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S MAIN ST STE B-100",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683851",
            "telephone_number": "714-541-0101",
            "fax_number": "714-541-0450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREASTLINK MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "BERGER",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "GERALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-445-2951"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2019; 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.