Wilshire Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

WILSHIRE ENDOSCOPY CENTER LLC

Practice address

3200 Wilshire Blvd
Ste 101
Los Angeles, CA 90010-1333

Phone

(213) 739-9988

NPI assigned

Oct 10, 2016

Organization subpart

No

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

Authorized official

Name

Eric Boon

Title

Officer/Ao

Phone

(480) 567-0269

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Wilshire Endoscopy Center LLCCCN 05C0001576

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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

{
    "created_epoch": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1174073506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 WILSHIRE BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 WILSHIRE BLVD",
            "address_2": "STE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101333",
            "telephone_number": "213-739-9988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILSHIRE ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OFFICER/AO",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wilshire Center for Cosmetic Surgery, a Professional Corporation
• Wilshire Center for Dermatology, a Professional Corporation
• Wilshire Co Medical Group Inc
• Wilshire Dermatology Medical Group, Inc.
• Wilshire District Medical Group
• Wilshire Foot and Ankle, Inc.
• Wilshire Health Services Inc (Cosmopolitan Health Services)
• Wilshire Healthcare Center LLC (Country Villa Wilshire Healthcare Center)
• Wilshire Home Health Inc
• Wilshire Home Health, Inc.

• Ambulatory Surgical Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; 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.