Active NPI
Geriatric Medical Associates of Nevada LLC
- Geriatric Medicine (Internal Medicine) Physician
- Las Vegas, NV
National Provider Identifier
1295986214
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- 1024
- Legal business name
- GERIATRIC MEDICAL ASSOCIATES OF NEVADA LLC
- Practice address
- 9811 W Charleston Blvd
Suite 2-304
Las Vegas, NV 89117-7528 - Phone
- (702) 464-7855
- Fax
- (702) 921-6828
- NPI assigned
- Oct 8, 2008
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mike Jeong, DO
- Title
- Owner
- Phone
- (702) 328-3283
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | 1024 | NV | Primary |
Addresses
Primary practice location
9811 W Charleston Blvd
Suite 2-304
Las Vegas, NV 89117-7528
Mailing address
9811 W Charleston Blvd
Suite 2-304
Las Vegas, NV 89117-7528
Phone (702) 464-7855
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002018471 | Medicaid | NV |
National Provider Directory
National Provider Directory- Tax ID family
- Geriatric Medical Associates of Nevada LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Geriatric Medicine (Internal Medicine) Physician
- Las Vegas, NV
- NPI 1235395484
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Geriatric Medicine (Internal Medicine) Physician
- Las Vegas, NV
- NPI 1144251075
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223424000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1235692800000",
"number": "1295986214",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9811 W CHARLESTON BLVD",
"address_2": "SUITE 2-304",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891177528",
"telephone_number": "702-464-7855",
"fax_number": "702-921-6828"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9811 W CHARLESTON BLVD",
"address_2": "SUITE 2-304",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891177528",
"telephone_number": "702-464-7855",
"fax_number": "702-921-6828"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GERIATRIC MEDICAL ASSOCIATES OF NEVADA LLC",
"organizational_subpart": "NO",
"enumeration_date": "2008-10-08",
"last_updated": "2009-02-27",
"status": "A",
"authorized_official_last_name": "JEONG",
"authorized_official_first_name": "MIKE",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "702-328-3283",
"authorized_official_credential": "DO"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "NV",
"license": "1024",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "002018471",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.