NPIMap

Organization Active NPI

Geriatric Medical Associates of Nevada LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
National Provider Identifier
1235395484
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
1024 Issued in NV
Legal business name
GERIATRIC MEDICAL ASSOCIATES OF NEVADA LLC
Practice address
9811 W Charleston Blvd
Suite# 2-304
Las Vegas, NV 89117-7528
Phone
(702) 464-7855
NPI assigned
Aug 6, 2008
Last updated
May 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Authorized official

Name
Mike Y Jeong, DONPI 1144251075
Title
President
Phone
(702) 443-6054

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
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0300X 1024 NV Primary

Addresses

Primary practice location

9811 W Charleston Blvd
Suite# 2-304
Las Vegas, NV 89117-7528

Mailing address

9811 W Charleston Blvd
Suite# 2-304
Las Vegas, NV 89117-7528
Phone (702) 464-7855

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081208000522 NV Part B Supplier - Clinic/Group Practice 5890856983 Receives reassigned benefits from 5 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory
Tax ID family
Geriatric Medical Associates of Nevada LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

9811 W Charleston Blvd
#2304
Las Vegas, NV 89117
Phone (702) 791-1414

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1217980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1235395484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9811 W CHARLESTON BLVD",
            "address_2": "SUITE# 2-304",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177528",
            "telephone_number": "702-464-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9811 W CHARLESTON BLVD",
            "address_2": "SUITE# 2-304",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891177528",
            "telephone_number": "702-464-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GERIATRIC MEDICAL ASSOCIATES OF NEVADA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-06",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "JEONG",
        "authorized_official_first_name": "MIKE",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-443-6054",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NV",
            "license": "1024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.