Individual provider Active NPI

Caroline O Egekeze, M.D.

  • Pediatrics Physician
  • Lynwood, CA
National Provider Identifier
1407873102
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A86266 Issued in CA
Practice address
3737 Martin Luther King Jr Blvd
Suite 204
Lynwood, CA 90262-3513
Phone
(310) 537-1221
Fax
(310) 764-2409
NPI assigned
Jul 17, 2006
Last updated
Dec 6, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A86266 CA Primary

Addresses

Primary practice location

3737 Martin Luther King Jr Blvd
Suite 204
Lynwood, CA 90262-3513

Mailing address

3737 Martin Luther King Jr Blvd
Suite 204
Lynwood, CA 90262-3513
Phone (310) 537-1221

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080214000600 CA Practitioner - Family PracticePractitioner - Pediatric Medicine 0042393985 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
T H E Clinic Inc CurrentSince Jun 6, 2023 Accepting new patients
Mission City Community Network, Inc. CurrentSince Oct 15, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 31, 2012 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 31, 2012 Accepting new patients
Mission City Community Network, Inc. Current Accepting new patients
Mission City Community Network, Inc. CurrentSince Oct 15, 2019 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
James E. Saunders, M.D., Inc. Past Accepting new patients

Locations

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

3834 S Western Ave
Los Angeles, CA 90062
Phone (323) 730-1920

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

8363 Reseda Blvd
Ste 11
Northridge, CA 91324
Phone 8188953100602

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

15206 Parthenia St
Sepulveda, CA 91343

3900 Alamo St
Simi Valley, CA 93063
Phone (805) 582-0100

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: caroline.egekeze@theci.eclinicaldirectplus.com

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1407873102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 MARTIN LUTHER KING JR BLVD",
            "address_2": "SUITE 204",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902623513",
            "telephone_number": "310-537-1221",
            "fax_number": "310-764-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 MARTIN LUTHER KING JR BLVD",
            "address_2": "SUITE 204",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902623513",
            "telephone_number": "310-537-1221",
            "fax_number": "310-764-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGEKEZE",
        "first_name": "CAROLINE",
        "middle_name": "O",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A86266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lynwood, CA

Sources for this page

Verify at the official NPI Registry.