Organization Active NPI

Interventional Cardiology Medical Group, Inc

  • Cardiovascular Disease Physician
  • West Hills, CA
National Provider Identifier
1396719480
Registry record updated Jul 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
INTERVENTIONAL CARDIOLOGY MEDICAL GROUP, INC
Practice address
7301 Medical Center Dr Ste 201
West Hills, CA 91307-1935
Phone
(818) 702-8800
Fax
(818) 702-0080
NPI assigned
Feb 15, 2006
Last updated
Jul 7, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2025

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

Authorized official

Name
Lacie Connolly
Title
Director of Operations & Devlopment
Phone
(818) 702-8800

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X CA Primary
Interventional Cardiology Physician 207RI0011X CA
Nuclear Imaging & Therapy Physician 207UN0902X CA

Addresses

Primary practice location

7301 Medical Center Dr Ste 201
West Hills, CA 91307-1935

Mailing address

7301 Medical Center Dr Ste 201
West Hills, CA 91307-1935
Phone (818) 702-8800

Other practice location 1

227 W Janss Rd Ste 310
Thousand Oaks, CA 91360-1889
Phone (805) 576-7533

Other practice location 2

2230 Lynn Rd Ste 101
Thousand Oaks, CA 91360-1917
Phone (805) 576-7533

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041220000503 CA Part B Supplier - Clinic/Group Practice 7214994482 Receives reassigned benefits from 8 practitioners
Practice locations: Thousand Oaks, CA; West Hills, CA

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
05D0963455Interventional Cardiology Medical Group Inc7301 Medical Center Drive, Suite 201, West Hills, CA 91307Certificate of waiverJul 28, 2027
05D2325167Interventional Cardiology Medical Group, Inc2230 Lynn Road, #101, Thousand Oaks, CA 91360Certificate of waiverJun 8, 2027

National Provider Directory

National Provider Directory

Locations

2230 Lynn Rd
Ste 101
Thousand Oaks, CA 91360
Phone (805) 557-9930

7230 Medical Center Dr
Ste 400
West Hills, CA 91307
Phone (818) 251-1965

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751846400000",
    "number": "1396719480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7301 MEDICAL CENTER DR STE 201",
            "city": "WEST HILLS",
            "state": "CA",
            "postal_code": "913071935",
            "telephone_number": "818-702-8800",
            "fax_number": "818-702-0080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301 MEDICAL CENTER DR STE 201",
            "city": "WEST HILLS",
            "state": "CA",
            "postal_code": "913071935",
            "telephone_number": "818-702-8800",
            "fax_number": "818-702-0080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "227 W Janss Rd Ste 310",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913601889",
            "country_code": "US",
            "telephone_number": "805-576-7533",
            "fax_number": "818-702-0080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2230 Lynn Rd Ste 101",
            "address_purpose": "LOCATION",
            "city": "Thousand Oaks",
            "state": "CA",
            "postal_code": "913601917",
            "country_code": "US",
            "telephone_number": "805-576-7533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTERVENTIONAL CARDIOLOGY MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A",
        "authorized_official_last_name": "CONNOLLY",
        "authorized_official_first_name": "LACIE",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS & DEVLOPMENT",
        "authorized_official_telephone_number": "818-702-8800"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0902X",
            "taxonomy_group": "",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; 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.