Organization Active NPI

Susan Pekarovics MD a Professional Corporation

  • Endocrinology, Diabetes & Metabolism Physician
  • Los Angeles, CA
National Provider Identifier
1235430505
Registry record updated Jun 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
A56360 Issued in CA
Legal business name
SUSAN PEKAROVICS MD A PROFESSIONAL CORPORATION
Practice address
6360 Wilshire Blvd
Suite 202
Los Angeles, CA 90048-5603
Phone
(323) 951-4916
Fax
(323) 951-4717
NPI assigned
Nov 3, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2012

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

Authorized official

Name
Dr. Susan Pekarovics, M.D.NPI 1154350320
Title
President
Phone
(323) 951-4916

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
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RE0101X A56360 CA Primary

Addresses

Primary practice location

6360 Wilshire Blvd
Suite 202
Los Angeles, CA 90048-5603

Mailing address

6360 Wilshire Blvd
Suite 202
Los Angeles, CA 90048-5603
Phone (323) 951-4916

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110525000071 CA Part B Supplier - Clinic/Group Practice 9638355738 Receives reassigned benefits from 1 practitioner
Practice locations: Los Angeles, CA; West Hollywood, CA

National Provider Directory

National Provider Directory

Locations

533 N Fairfax Ave
Los Angeles, CA 90036
Phone (323) 931-1061

6360 Wilshire Blvd
Ste 202
Los Angeles, CA 90048
Phone (323) 653-4220

Practitioners & affiliated clinicians

Practitioners 1

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": "1288742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339200000000",
    "number": "1235430505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6360 WILSHIRE BLVD",
            "address_2": "SUITE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485603",
            "telephone_number": "323-951-4916",
            "fax_number": "323-951-4717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6360 WILSHIRE BLVD",
            "address_2": "SUITE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485603",
            "telephone_number": "323-951-4916",
            "fax_number": "323-951-4717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUSAN PEKAROVICS MD A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-03",
        "last_updated": "2012-06-09",
        "status": "A",
        "authorized_official_last_name": "PEKAROVICS",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-951-4916",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "A56360",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2012; 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.