Jack Booker Anderson II

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Practice address

879 W 190TH St Ste 400
Gardena, CA 90248-4223

Phone

(310) 887-6382

NPI assigned

Jun 25, 2021

Last updated

Feb 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Five Star Non-Emergency Medical Transportation

  • Non-emergency Medical Transport (VAN)
  • Los Angeles, CA
  • NPI 1548832678
  NPD Authorized official

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

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1215507983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 470323",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900470323",
            "telephone_number": "310-490-7570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "879 W 190TH ST STE 400",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484223",
            "telephone_number": "310-887-6382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "JACK",
        "middle_name": "BOOKER",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-25",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annette Michelle Andalon
• Lesha Anddrews
• Anna Mikhailovna Anderson
• Carisyn Anderson
• Danielle Anderson, RADT
• Jessica Anderson
• Lofreshia Anderson
• Makiya Francine Anderson
• Mario Demetrius Anderson Sr.
• Megan Anderson

• Non-emergency Medical Transport (VAN) in Gardena, CA
• Providers in Gardena, CA by specialty
• Non-emergency Medical Transport (VAN) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.