Jaga Medical Group Inc

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

20A7285 Issued in CA

Legal business name

JAGA MEDICAL GROUP INC

Practice address

1400 Colorado Blvd
A
Eagle Rock, CA 90041-2321

Phone

(323) 999-2250

Fax

(323) 999-2241

NPI assigned

Sep 7, 2016

Last updated

Oct 20, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ardienne Ann Grant, D.O.

Title

President

Phone

(323) 999-2250

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

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.

• Adrienne Ann Grant, D.O.

  • General Practice Physician
  • Long Beach, CA
  • NPI 1063571834
  Medicare reassignment NPD
• Meri Petrosyan, FNP-C

  • Family Nurse Practitioner
  • Glendale, CA
  • NPI 1306513270
  Medicare reassignment NPD

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476921600000",
    "number": "1356898357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 COLORADO BLVD",
            "address_2": "A",
            "city": "EAGLE ROCK",
            "state": "CA",
            "postal_code": "900412321",
            "telephone_number": "323-999-2250",
            "fax_number": "323-999-2241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 COLORADO BLVD",
            "address_2": "A",
            "city": "EAGLE ROCK",
            "state": "CA",
            "postal_code": "900412321",
            "telephone_number": "323-999-2250",
            "fax_number": "323-999-2241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAGA MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-10-20",
        "status": "A",
        "authorized_official_last_name": "GRANT",
        "authorized_official_first_name": "ARDIENNE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-999-2250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "20A7285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Physician in Eagle Rock, CA
• Providers in Eagle Rock, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2016; 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.