90210 Surgery Medical Center, LLC

Key facts

NPI: 1295769131
Entity type: Organization (NPI type 2)
Primary specialty: Ophthalmologic Surgery Clinic/Center 261QS0132X
Legal business name: 90210 SURGERY MEDICAL CENTER, LLC
Practice address: 450 N Roxbury Dr
Suite 600
Beverly Hills, CA 90210-4232
Phone: (310) 651-2280
Fax: (310) 651-2260
NPI assigned: Jul 10, 2006
Organization subpart: No

Authorized official

Name: Janna L. Esparza
Title: Director of Operations
Phone: (951) 699-0303

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

90210 Surgery Medical Center, LLC Ambulatory Surgical Clinic/Center · Beverly Hills, CA · NPI 1902851009

Same PAC ID 8628162690

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Cedars-Sinai Medical Center General Acute Care Hospital · West Hollywood, CA · NPI 1891940326

NPD member Member Of

Practitioners 2

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

David Josephson, MD Urology Physician · Los Angeles, CA · NPI 1063510840

NPD
Babak Baravarian, DPM Podiatrist · Santa Monica, CA · NPI 1952310799

NPD (past)

Medicare Care Compare: Ambulatory surgical center

Listed as: 90210 Surgery Medical Center LLC CCN 05C0001031
Medicare certification status: Active (Provider of Services file)

Source: Medicare Care Compare.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
05D0919097	90210 Surgery Medical Center 450 N Roxbury Dr, Ste 600, Beverly Hills, CA 90210	Certificate of waiver	Nov 7, 2027

Medicare participation

Medicare fee-for-service enrollment: Enrolled in CA

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20070920000921	CA	Part B Supplier - Ambulatory Surgical Center	8628162690	Practice locations: Beverly Hills, CA

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Ophthalmologic Surgery Clinic/Center	261QS0132X		CA	Yes

Addresses

Primary practice location

450 N Roxbury Dr
Suite 600
Beverly Hills, CA 90210-4232

Mailing address

450 N Roxbury Dr
Suite 600
Beverly Hills, CA 90210-4232
Phone (310) 651-2280

Other identifiers

Identifier	Type	State	Issuer
SUR01031G	Medicaid	CA

Other names

90210 SURGERY CENTER, LLC Other name

Other providers in Beverly Hills, CA

All providers in Beverly Hills, CA · Ophthalmologic Surgery Clinic/Center in California

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2007. 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.

Verify at the official NPI Registry.