Brookdale Medical Center Inc
Organization Active NPI Pediatrics Physician · South Gate, CA
NPI 1265572903 · NPPES record last updated Dec 23, 2010
Key facts
- NPI
- 1265572903
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- OA44541 (CA)
- Legal business name
- BROOKDALE MEDICAL CENTER INC
- Practice address
- 2809 Tweedy Blvd
South Gate, CA 90280 - Phone
- (323) 567-9909
- Fax
- (323) 567-9929
- NPI assigned
- Feb 8, 2007
- Organization subpart
- No
Authorized official
- Name
- John Barkodar, MD
- Title
- President
- Phone
- (323) 567-9909
Member organizations 1
Practitioners 1
-
Linda Barkodar, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1060478 | Brookdale Medical Center | Provider-performed microscopy | Oct 23, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110210000393 | CA | Part B Supplier - Clinic/Group Practice | 1557541489 |
Receives reassigned benefits from 1 practitioner Practice locations: South Gate, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician |
208000000X | OA44541 | CA | Yes |
| General Practice Physician |
208D00000X | OA44541 | CA |
Addresses
Primary practice location
2809 Tweedy Blvd
South Gate, CA 90280
Mailing address
2809 Tweedy Blvd
South Gate, CA 90280
Phone (323) 567-9909
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0102030 | Medicaid | CA |
Other providers in South Gate, CA
- Kenneth Bonner
- Yueh-Guei Sheu Book
- Stephanie Boorstin Casasola
- Boone Navath Bou
- Ricardo Bravo
- Leny Jovana Brotherton
- Emily Byrne
- Lucas Cadena
- Cali Med Corporation
- Joanna Campos
All providers in South Gate, CA · Pediatrics Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.