NPIMap

Organization Active NPI

Healing Hands Medical Group, a Medical Corporation

  • Nephrology Physician
  • Los Angeles, CA
National Provider Identifier
1184740367
Registry record updated Oct 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
C38014 Issued in CA
Legal business name
HEALING HANDS MEDICAL GROUP, A MEDICAL CORPORATION
Practice address
2975 Wilshire Blvd
Suite 401
Los Angeles, CA 90010-1107
Phone
(213) 368-1654
Fax
(213) 368-1658
NPI assigned
Mar 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2019

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

Authorized official

Name
Randall W Maxey, MDNPI 1700944279
Title
President
Phone
(213) 368-1654

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
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X C38014 CA Primary

Addresses

Primary practice location

2975 Wilshire Blvd
Suite 401
Los Angeles, CA 90010-1107

Mailing address

447 N Prairie Ave
Inglewood, CA 90301-4502
Phone (310) 680-1810

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071204000477 CA Part B Supplier - Clinic/Group Practice 5991894537 Receives reassigned benefits from 2 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

2975 Wilshire Blvd
Ste 401
Los Angeles, CA 90010
Phone (213) 368-1654

2975 Wilshire Blvd
Ste 450
Los Angeles, CA 90010
Phone (213) 368-1654

Practitioners & affiliated clinicians

Practitioners 4

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": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569974400000",
    "number": "1184740367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "447 N PRAIRIE AVE",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903014502",
            "telephone_number": "310-680-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2975 WILSHIRE BLVD",
            "address_2": "SUITE 401",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900101107",
            "telephone_number": "213-368-1654",
            "fax_number": "213-368-1658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALING HANDS MEDICAL GROUP, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2019-10-02",
        "status": "A",
        "authorized_official_last_name": "MAXEY",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-368-1654",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "C38014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.