NPIMap

Organization Active NPI

Martin Luther King Jr Community Medical Foundation

  • Radiology Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1346082294
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATION
Practice address
12021 Wilmington Ave Ste 1700
Los Angeles, CA 90059-3019
Phone
(424) 529-6755
NPI assigned
Jun 11, 2024
Last updated
Jun 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Authorized official

Name
Kurt Stauder
Title
President
Phone
(424) 338-8760

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU Primary

Addresses

Primary practice location

12021 Wilmington Ave Ste 1700
Los Angeles, CA 90059-3019

Mailing address

PO Box 840113
Los Angeles, CA 90084-0163
Phone (424) 529-6755

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250319003548 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 8628359502 Practice locations: Los Angeles, CA

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Martin Luther King Jr Commu6 organizations share this tax ID, including this one
Part of
Martin Luther King Jr Commu

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12021 Wilmington Ave
#1700
Los Angeles, CA 90059
Phone (424) 529-6755

12021 Wilmington Ave
Ste 1700
Los Angeles, CA 90059
Phone (424) 529-6755

Practitioners & affiliated clinicians

Practitioners 510

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.

View all 510

NPI Registry JSON

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

{
    "created_epoch": "1718064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718064000000",
    "number": "1346082294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840113",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900840163",
            "telephone_number": "424-529-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12021 WILMINGTON AVE STE 1700",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900593019",
            "telephone_number": "424-529-6755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARTIN LUTHER KING JR COMMUNITY MEDICAL FOUNDATION",
        "enumeration_date": "2024-06-11",
        "last_updated": "2024-06-11",
        "certification_date": "2024-03-19",
        "status": "A",
        "authorized_official_last_name": "STAUDER",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "424-338-8760"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "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 Jun 11, 2024; 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.