Innovative Medical Care a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

INNOVATIVE MEDICAL CARE A MEDICAL CORPORATION

Practice address

3527 Ocean View Blvd
Glendale, CA 91208

Phone

(747) 745-7771

Fax

(818) 484-2430

NPI assigned

Jun 26, 2023

Organization subpart

No

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

Authorized official

Name

Anna Manukyan, NPNPI 1003445768

Title

Authorized Official/Owner

Phone

(323) 600-5213

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

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

• Anna Manukyan

  • Primary Care Nurse Practitioner
  • Glendale, CA
  • NPI 1003445768
  Medicare reassignment NPD Authorized official
• Shomir Banerjee, MD

  • Family Medicine Physician
  • Salinas, CA
  • NPI 1932366200
  Medicare reassignment NPD

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

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1245916048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3527 OCEAN VIEW BLVD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912081211",
            "telephone_number": "323-600-5213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3527 OCEAN VIEW BLVD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91208",
            "telephone_number": "747-745-7771",
            "fax_number": "818-484-2430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDICAL CARE A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "MANUKYAN",
        "authorized_official_first_name": "ANNA",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL/OWNER",
        "authorized_official_telephone_number": "323-600-5213",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Glendale, CA
• Providers in Glendale, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.