NPIMap

Organization Active NPI

Prairie Medical Group

  • Specialist
  • Marina del Rey, CA
National Provider Identifier
1194846410
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
058963 Issued in CA
Legal business name
PRAIRIE MEDICAL GROUP
Practice address
4644 Lincoln Blvd
Suite 428
Marina del Rey, CA 90292
Phone
(310) 214-8677
Fax
(310) 921-1718
NPI assigned
Apr 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Christopher C Chidi, MD
Title
President
Phone
(310) 214-8677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X 058963 CA Primary

Addresses

Primary practice location

4644 Lincoln Blvd
Suite 428
Marina del Rey, CA 90292

Mailing address

Dept 2834
Los Angeles, CA 90084
Phone (310) 306-1888

Other identifiers 1

IdentifierTypeStateIssuer
GR0078675MedicaidCA

National Provider Directory

National Provider Directory

Locations

2825 Santa Monica Blvd
Ste 301
Santa Monica, CA 90404
Phone (310) 453-0123

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1194846410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 2834",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90084",
            "telephone_number": "310-306-1888",
            "fax_number": "310-577-8290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4644 LINCOLN BLVD",
            "address_2": "SUITE 428",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "90292",
            "telephone_number": "310-214-8677",
            "fax_number": "310-921-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHIDI",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-214-8677",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "058963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0078675",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marina del Rey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.