Active NPI
Bartholomew Gilliam, PA-C
- Physician Assistant
- Los Angeles, CA
National Provider Identifier
1285776153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA13669
- Practice address
- 12012 S Wilmington Avenue
Los Angeles, CA 90059 - Phone
- (310) 668-4515
- Fax
- (310) 763-8909
- NPI assigned
- Feb 13, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA13669 | CA | Primary |
Addresses
Primary practice location
12012 S Wilmington Avenue
Los Angeles, CA 90059
Mailing address
19012 S Grandee Avenue
Carson, CA 90746
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of Los Angeles | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Los Angeles, CA
- NPI 1780877613
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171324800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285776153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19012 S GRANDEE AVENUE",
"city": "CARSON",
"state": "CA",
"postal_code": "90746"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12012 S WILMINGTON AVENUE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90059",
"telephone_number": "310-668-4515",
"fax_number": "310-763-8909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIAM",
"first_name": "BARTHOLOMEW",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA13669",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.