NPIMap

Organization Active NPI

Stevenson Orthopaedic Medical Clinic

  • Orthopaedic Surgery Physician
  • Inglewood, CA
National Provider Identifier
1376638965
Registry record updated Apr 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
G48296 Issued in CA
Legal business name
STEVENSON ORTHOPAEDIC MEDICAL CLINIC
Practice address
575 E Hardy St
Suite 105
Inglewood, CA 90301-4040
Phone
(310) 674-1211
Fax
(310) 674-8668
NPI assigned
Oct 3, 2006
Last updated
Apr 5, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2012

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

Authorized official

Name
Dr. Donald V Stevenson, M.D.NPI 1770584047
Title
President
Phone
(310) 674-1211

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
Orthopaedic Surgery Physician 207X00000X G48296 CA Primary

Addresses

Primary practice location

575 E Hardy St
Suite 105
Inglewood, CA 90301-4040

Mailing address

575 E Hardy St
Suite 105
Inglewood, CA 90301-4040
Phone (310) 674-1211

Other identifiers 1

IdentifierTypeStateIssuer
00G482960MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101014000291 CA Part B Supplier - Clinic/Group Practice 0648480277 Receives reassigned benefits from 2 practitioners
Practice locations: Inglewood, CA

National Provider Directory

National Provider Directory

Locations

575 E Hardy St
Ste 105
Inglewood, CA 90301
Phone (310) 412-0100

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333584000000",
    "number": "1376638965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 E HARDY ST",
            "address_2": "SUITE 105",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903014040",
            "telephone_number": "310-674-1211",
            "fax_number": "310-674-8668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 E HARDY ST",
            "address_2": "SUITE 105",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903014040",
            "telephone_number": "310-674-1211",
            "fax_number": "310-674-8668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEVENSON ORTHOPAEDIC MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2012-04-05",
        "status": "A",
        "authorized_official_last_name": "STEVENSON",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-674-1211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G48296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G482960",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; 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.