NPIMap

Organization Active NPI

Mercy Eye Care Medical Group Inc

  • Ophthalmology Physician
  • Montebello, CA
National Provider Identifier
1154495307
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
A48969 Issued in CA
Legal business name
MERCY EYE CARE MEDICAL GROUP INC
Practice address
1717 W Beverly Blvd Ste a
Montebello, CA 90640-3971
Phone
(323) 724-1075
Fax
(323) 724-1198
NPI assigned
Nov 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

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

Authorized official

Name
Sandeep K Khanna, M.D.NPI 1366514044
Title
President
Phone
(323) 526-7235

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
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X A48969 CA Primary

Addresses

Primary practice location

1717 W Beverly Blvd Ste a
Montebello, CA 90640-3971

Mailing address

1700 E Cesar E Chavez Ave Ste 3400
Los Angeles, CA 90033-2469
Phone (323) 526-7273

Other identifiers 1

IdentifierTypeStateIssuer
00A489692MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070605000712 CA Part B Supplier - Clinic/Group Practice 1951409572 Receives reassigned benefits from 6 practitioners
2 other NPIs on this enrollment
Practice locations: Lakewood, CA; Los Angeles, CA; Montebello, 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
Mercy Eye Care3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1717 W Beverly Blvd
Ste A
Montebello, CA 90640
Phone (323) 724-1075

Interoperability endpoints

  • FHIR API: https://app.meldrx.com/api/fhir/Freedom_MEC

Practitioners & affiliated clinicians

Practitioners 7

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": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327363200000",
    "number": "1154495307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E CESAR E CHAVEZ AVE STE 3400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332469",
            "telephone_number": "323-526-7273",
            "fax_number": "323-526-7235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 W BEVERLY BLVD STE A",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906403971",
            "telephone_number": "323-724-1075",
            "fax_number": "323-724-1198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY EYE CARE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2012-01-24",
        "status": "A",
        "authorized_official_last_name": "KHANNA",
        "authorized_official_first_name": "SANDEEP",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-526-7235",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A48969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A489692",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montebello, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; 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.