NPIMap

Organization Active NPI

Prairie Medical Group Inc

  • Specialist
  • Santa Monica, CA
National Provider Identifier
1386790145
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
119553 Issued in CA
Legal business name
PRAIRIE MEDICAL GROUP INC
Practice address
2825 Santa Monica Blvd
Suite 301
Santa Monica, CA 90404
Phone
(310) 082-9313
Fax
(310) 828-9156
NPI assigned
Jan 26, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Christopher C Chidi, MD
Title
President
Phone
(310) 214-8677

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 119553 CA Primary

Addresses

Primary practice location

2825 Santa Monica Blvd
Suite 301
Santa Monica, CA 90404

Mailing address

Department No 2834
Los Angeles, CA 90084
Phone (310) 214-8677

Other identifiers 1

IdentifierTypeStateIssuer
GR0078674MedicaidCA

National Provider Directory

National Provider Directory

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": "1169769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1386790145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT NO 2834",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90084",
            "telephone_number": "310-214-8677",
            "fax_number": "310-921-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 SANTA MONICA BLVD",
            "address_2": "SUITE 301",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90404",
            "telephone_number": "310-082-9313",
            "fax_number": "310-828-9156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CHIDI",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-214-8677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "119553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0078674",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.