NPIMap

Organization Active NPI

Brotman Medical Anesthesia Group

  • Anesthesiology Physician
  • Woodland Hills, CA
National Provider Identifier
1154378362
Registry record updated Jul 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A69217 Issued in CA
Legal business name
BROTMAN MEDICAL ANESTHESIA GROUP
Practice address
20750 Ventura Blvd
Ste. #210
Woodland Hills, CA 91364-2338
Phone
(818) 888-7815
Fax
(818) 715-1722
NPI assigned
May 31, 2006
Last updated
Jul 19, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2017

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

Authorized official

Name
Michael Kelly, M.D.NPI 1891761276
Title
Direct Owner
Phone
(818) 888-7815

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A69217 CA Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X A69217 CA

Addresses

Primary practice location

20750 Ventura Blvd
Ste. #210
Woodland Hills, CA 91364-2338

Mailing address

PO Box 7001
Tarzana, CA 91357-7001
Phone (818) 888-7815

Other identifiers 1

IdentifierTypeStateIssuer
GR0103820OtherCAEDS MEDICAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061213000236 CA Part B Supplier - Clinic/Group Practice 8123027547 Receives reassigned benefits from 39 practitioners
Practice locations: Tarzana, CA; Northridge, CA; Los Angeles, CA; Encino, CA; Burbank, CA; Beverly Hills, CA; La Quinta, CA

National Provider Directory

National Provider Directory

Locations

16255 Ventura Blvd
Encino, CA 91436
Phone (818) 784-8975

18330 Roscoe Blvd
Northridge, CA 91325
Phone (747) 224-4004

1180 N Indian Canyon Dr
Ste W110
Palm Springs, CA 92262
Phone (760) 416-4600

5620 Wilbur Ave
Ste 207
Tarzana, CA 91356
Phone (818) 344-0070

20750 Ventura Blvd
Ste 210
Woodland Hls, CA 91364
Phone 8188007815100

Practitioners & affiliated clinicians

Practitioners 39

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.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1500422400000",
    "number": "1154378362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7001",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913577001",
            "telephone_number": "818-888-7815",
            "fax_number": "818-715-1722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20750 VENTURA BLVD",
            "address_2": "STE. #210",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913642338",
            "telephone_number": "818-888-7815",
            "fax_number": "818-715-1722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROTMAN MEDICAL ANESTHESIA GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2017-07-19",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "DIRECT OWNER",
        "authorized_official_telephone_number": "818-888-7815",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A69217",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "CA",
            "license": "A69217",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDS MEDICAL",
            "identifier": "GR0103820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2017; 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.