NPIMap

Organization Active NPI

Advanced Lung Center Medical Group Inc.

  • Pulmonary Disease Physician
  • Inglewood, CA
National Provider Identifier
1164593323
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
A52081 Issued in CA
Legal business name
ADVANCED LUNG CENTER MEDICAL GROUP INC.
Practice address
401 S la Brea Ave Ste 205
Inglewood, CA 90301-2321
Phone
(310) 275-7575
NPI assigned
Nov 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

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

Authorized official

Name
Jamshid Niknam, M.D.NPI 1134132798
Title
President
Phone
(310) 275-7575

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
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X A52081 CA
Pulmonary Disease PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RP1001X A52081 CA Primary

Addresses

Primary practice location

401 S la Brea Ave Ste 205
Inglewood, CA 90301-2321

Mailing address

401 S la Brea Ave Ste 205
Inglewood, CA 90301-2321
Phone (310) 275-7575

Other identifiers 1

IdentifierTypeStateIssuer
00A520810MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040210000876 CA Part B Supplier - Clinic/Group Practice 4082508197 Receives reassigned benefits from 11 practitioners
Practice locations: Inglewood, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1055435Advanced Lung Center Medical Group401 S la Brea Ave, Inglewood, CA 90301Certificate of waiverMay 14, 2028

National Provider Directory

National Provider Directory

Locations

401 S La Brea Ave
Ste 205
Inglewood, CA 90301
Phone (310) 275-7575

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 & affiliated clinicians

Practitioners 11

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": "1163116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398124800000",
    "number": "1164593323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S LA BREA AVE STE 205",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903012321",
            "telephone_number": "310-275-7575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S LA BREA AVE STE 205",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903012321",
            "telephone_number": "310-275-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED LUNG CENTER MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-10",
        "last_updated": "2014-04-22",
        "status": "A",
        "authorized_official_last_name": "NIKNAM",
        "authorized_official_first_name": "JAMSHID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-275-7575",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A52081",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A52081",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A520810",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.