Active NPI
Southern California Kidney Consultants Inc.
- Nephrology Physician
- Garden Grove, CA
National Provider Identifier
1205934783
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- G24122
- Legal business name
- SOUTHERN CALIFORNIA KIDNEY CONSULTANTS INC.
- Practice address
- 12665 Garden Grove Blvd
Ste 211
Garden Grove, CA 92843-1901 - Phone
- (714) 636-2890
- Fax
- (714) 636-2909
- NPI assigned
- Sep 20, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Elizabeth A Gonzalez
- Title
- Administrator
- Phone
- (714) 636-2890
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | G24122 | CA | Primary |
Addresses
Primary practice location
12665 Garden Grove Blvd
Ste 211
Garden Grove, CA 92843-1901
Mailing address
12665 Garden Grove Blvd
Ste 211
Garden Grove, CA 92843-1901
Phone (714) 636-2890
Other practice location 1
5451 La Palma Ave Ste 47
LA Palma, CA 90623-1732
Phone (714) 562-8560
Other practice location 2
100 E Valencia Mesa Dr Ste 217
Fullerton, CA 92835-3800
Phone (714) 992-5581
Other practice location 3
1019 W La Palma Ave Unit A
Anaheim, CA 92801-3664
Phone (714) 956-5200
Other practice location 4
1310 W Stewart Dr Ste 210
Orange, CA 92868-3837
Phone (714) 836-4204
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ75439Z | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040417000613 | CA | Part B Supplier - Clinic/Group Practice | 6103811286 |
Receives reassigned benefits from 29 practitioners Practice locations: Garden Grove, CA |
National Provider Directory
National Provider DirectoryLocations
12665 Garden Grove Blvd
#217
Garden Grove, CA 92843
5451 La Palma Ave
La Palma, CA 90623
Phone (714) 521-2290
721 W 1st St
Tustin, CA 92780
Phone (714) 544-0079
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- https://api.platform.athenahealth.com/21072/brand/1/csg/1/fhir/r4
Practitioners & affiliated clinicians
Practitioners 29
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": "1158710400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1539648000000",
"number": "1205934783",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12665 GARDEN GROVE BLVD",
"address_2": "STE 211",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928431901",
"telephone_number": "714-636-2890",
"fax_number": "714-636-2909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12665 GARDEN GROVE BLVD",
"address_2": "STE 211",
"city": "GARDEN GROVE",
"state": "CA",
"postal_code": "928431901",
"telephone_number": "714-636-2890",
"fax_number": "714-636-2909"
}
],
"practiceLocations": [
{
"address_1": "5451 La Palma Ave Ste 47",
"address_purpose": "LOCATION",
"city": "LA Palma",
"state": "CA",
"postal_code": "906231732",
"country_code": "US",
"telephone_number": "714-562-8560",
"fax_number": "714-562-8563",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "100 E Valencia Mesa Dr Ste 217",
"address_purpose": "LOCATION",
"city": "Fullerton",
"state": "CA",
"postal_code": "928353800",
"country_code": "US",
"telephone_number": "714-992-5581",
"fax_number": "714-992-2950",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1019 W La Palma Ave Unit A",
"address_purpose": "LOCATION",
"city": "Anaheim",
"state": "CA",
"postal_code": "928013664",
"country_code": "US",
"telephone_number": "714-956-5200",
"fax_number": "714-956-4614",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1310 W Stewart Dr Ste 210",
"address_purpose": "LOCATION",
"city": "Orange",
"state": "CA",
"postal_code": "928683837",
"country_code": "US",
"telephone_number": "714-836-4204",
"fax_number": "714-836-1809",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "SOUTHERN CALIFORNIA KIDNEY CONSULTANTS INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-20",
"last_updated": "2018-10-16",
"status": "A",
"authorized_official_last_name": "GONZALEZ",
"authorized_official_first_name": "ELIZABETH",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "714-636-2890"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "G24122",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ZZZ75439Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Garden Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; 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.