Modern Concepts Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MODERN CONCEPTS MEDICAL GROUP

Practice address

50 Bellefontaine St
404
Pasadena, CA 91105-3132

Phone

(323) 728-6070

Fax

(323) 728-2912

NPI assigned

May 11, 2007

Organization subpart

No

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

Authorized official

Name

Margaret Herrera, MD

Title

President

Phone

(323) 728-6070

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Modern Concepts Medical Group, Inc

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1386859619

  O20040302001418

  Same enrollment
• Modern Concepts Medical Group, Inc

  • Family Medicine Physician
  • Montebello, CA
  • NPI 1790738243

  O20040302001418

  Same enrollment

Locations

Practitioners 4

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

• Violkys Bustamante, PA-C

  • Family Medicine Physician
  • Montebello, CA
  • NPI 1386755759
  NPD (past)
• Jacqueline Hayata

  • Physician Assistant
  • Los Angeles, CA
  • NPI 1861071102
  NPD (past)
• Beringia Liu, MPH

  • Physician Assistant
  • Los Angeles, CA
  • NPI 1801565494
  NPD (past)
• Roberto Madrid, MD

  • Family Medicine Physician
  • Montebello, CA
  • NPI 1508889585
  NPD (past)

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1194930420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 640",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906400640",
            "telephone_number": "323-728-6070",
            "fax_number": "323-728-2912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 BELLEFONTAINE ST",
            "address_2": "404",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911053132",
            "telephone_number": "323-728-6070",
            "fax_number": "323-728-2912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN CONCEPTS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HERRERA",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-728-6070",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA WAIVER",
            "identifier": "05D0936983",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6495234",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0084064",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1346358827",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Pasadena, CA
• Providers in Pasadena, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.