NPIMap

Organization Active NPI

Western Pacific Med-Corp

  • Methadone Clinic
  • Mission Viejo, CA
National Provider Identifier
1386280899
Registry record updated Nov 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Methadone ClinicTaxonomy code 261QM2800X
Legal business name
WESTERN PACIFIC MED-CORP
Practice address
26921 Crown Valley Pkwy Ste 200
Mission Viejo, CA 92691-6501
Phone
(818) 956-3737
Fax
(818) 543-6767
NPI assigned
Nov 19, 2019
Last updated
Nov 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2019

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

Authorized official

Name
Mr. Jeffery Steven Blake
Title
Director of Operations
Phone
(818) 956-3737

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Methadone Clinic 261QM2800X Primary

Addresses

Primary practice location

26921 Crown Valley Pkwy Ste 200
Mission Viejo, CA 92691-6501

Mailing address

4544 San Fernando Rd Ste 202
Glendale, CA 91204-5015
Phone (818) 956-3737

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200214000625 CA Part B Supplier - Opioid Treatment Program (Otp) 5597738443 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mission Viejo, CA; Ventura, CA; Van Nuys, CA; Stanton, CA; Reseda, CA; Panorama City, CA; Norwalk, CA; North Hollywood, CA…

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2242266Western Pacific Med-Corp26921 Crown Valley Parkway Ste #200, Mission Viejo, CA 92691Certificate of waiverNov 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Western Pacific Med-Corp19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

4838 Laurel Canyon Blvd
North Hollywood, CA 91607
Phone (818) 506-4455

7232 Canby Ave
Ste 456
Reseda, CA 91335
Phone (818) 705-5561

14332 Victory Blvd
Van Nuys, CA 91401
Phone (818) 989-1996

9462 Van Nuys Blvd
Van Nuys, CA 91402
Phone (818) 891-8555

Practitioners & affiliated clinicians

Practitioners 79

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 79

NPI Registry JSON

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

{
    "created_epoch": "1574121600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1574121600000",
    "number": "1386280899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4544 SAN FERNANDO RD STE 202",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912045015",
            "telephone_number": "818-956-3737",
            "fax_number": "818-543-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26921 CROWN VALLEY PKWY STE 200",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916501",
            "telephone_number": "818-956-3737",
            "fax_number": "818-543-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN PACIFIC MED-CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-19",
        "last_updated": "2019-11-19",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "818-956-3737",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM2800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Methadone",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.