NPIMap

Organization Active NPI

Premier Nephrology Medical Group, Inc.

  • Nephrology Physician
  • Los Angeles, CA
National Provider Identifier
1316079106
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
PREMIER NEPHROLOGY MEDICAL GROUP, INC.
Practice address
1400 S Grand Ave
Ste. 800
Los Angeles, CA 90015-3048
Phone
(213) 748-1414
Fax
(213) 749-4021
NPI assigned
Mar 9, 2007
Last updated
Jul 13, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

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

Authorized official

Name
Dr. Bruce A Greenfield, MDNPI 1043224686
Title
President
Phone
(213) 742-1414

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)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X NU Primary

Addresses

Primary practice location

1400 S Grand Ave
Ste. 800
Los Angeles, CA 90015-3048

Mailing address

1400 S Grand Ave
Ste. 800
Los Angeles, CA 90015-3048
Phone (213) 748-1414

Other identifiers 1

IdentifierTypeStateIssuer
GR0065330MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040617000925 CA Part B Supplier - Clinic/Group Practice 5193709947 Receives reassigned benefits from 7 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

1400 S Grand Ave
Ste 800
Los Angeles, CA 90015
Phone (213) 748-1414

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184284800000",
    "number": "1316079106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 S GRAND AVE",
            "address_2": "STE. 800",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153048",
            "telephone_number": "213-748-1414",
            "fax_number": "213-749-4021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S GRAND AVE",
            "address_2": "STE. 800",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153048",
            "telephone_number": "213-748-1414",
            "fax_number": "213-749-4021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER NEPHROLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2007-07-13",
        "status": "A",
        "authorized_official_last_name": "GREENFIELD",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-742-1414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0065330",
            "state": "CA"
        }
    ],
    "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 13, 2007; 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.