NPIMap

Individual provider Active NPI

Paul Gregerson, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1417022336
Registry record updated Oct 20, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G55695 Issued in CA
Practice address
522 S San Pedro St
Los Angeles, CA 90013-2102
Phone
(213) 486-4929
Fax
(213) 627-4043
NPI assigned
Nov 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G55695 CA Primary

Addresses

Primary practice location

522 S San Pedro St
Los Angeles, CA 90013-2102

Mailing address

8210 Bellgave PL
Los Angeles, CA 90069-1601
Phone (213) 706-4211

Other identifiers 1

IdentifierTypeStateIssuer
WG55695AOtherCAPPIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070117000559 CA Practitioner - Internal MedicinePractitioner - General Practice 1153320825 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G55695CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
JWCH Institute Inc CurrentSince Nov 10, 2016 Accepting new patients
JWCH Institute Inc CurrentSince Nov 10, 2016 Accepting new patients

Locations

5650 Jillson St
Commerce, CA 90040
Phone (213) 484-1186

522 S San Pedro St
Los Angeles, CA 90013
Phone (213) 486-4085

12360 Firestone Blvd
Norwalk, CA 90650
Phone (562) 281-0305

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: paul.gregersonmd.p1@direct.jwch.nextgenshare.com

Ownership & related parties

All facility ownership & control disclosures 28

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
JWCH Institute Inc Medical Clinic Weingart CenterLos Angeles, CA, CCN 051068 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers (Bellflower)Bellflower, CA, CCN 051069 Federally qualified health center Corporate Officer Jan 1, 2001
Bell Gardens Community Health CenterBell Gardens, CA, CCN 051067 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - VermontLos Angeles, CA, CCN 551043 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Center (Lynwood)Lynwood, CA, CCN 551045 Federally qualified health center Corporate Officer (6.66%) Jan 1, 2001
JWCH Norwalk Regional Health CenterNorwalk, CA, CCN 551044 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers (Downey)Downey, CA, CCN 751826 Federally qualified health center Corporate Officer Jan 1, 2001
JWCH Medical Clinic at Downtown Women'S CenterLos Angeles, CA, CCN 751881 Federally qualified health center Corporate Officer Jan 1, 2001
JWCH Medical Clinic @ St. George HotelLos Angeles, CA, CCN 751882 Federally qualified health center Corporate Officer Jan 1, 2001
JWCH Medical Clinic @ Bell ShelterBell, CA, CCN 751883 Federally qualified health center Corporate Officer Jan 1, 2001
JWCH Medical Clinic @ WeingartLos Angeles, CA, CCN 751891 Federally qualified health center Corporate Officer Jan 1, 2001
JWCH Institute IncLos Angeles, CA, CCN 751900 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - Palmdale EastPalmdale, CA, CCN 921168 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - Palmdale CentralPalmdale, CA, CCN 921169 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - Health and Wellness CenterLancaster, CA, CCN 921170 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - Lynwood Middle SchoolLynwood, CA, CCN A01081 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - WhittierWhittier, CA, CCN 921827 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers Andrew Escajeda ClinicPasadena, CA, CCN 921821 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - MLK Recuperative Care CenterLos Angeles, CA, CCN 921822 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - Hacienda HeightsHacienda Heights, CA, CCN 921826 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - MLK Recuperative Care CenterLos Angeles, CA, CCN A01080 Federally qualified health center Corporate Officer Jan 1, 2001
Student Health & Wellness CenterLos Angeles, CA, CCN 921942 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - Vermont AnnexLos Angeles, CA, CCN 921940 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - LynwoodLynwood, CA, CCN 921936 Federally qualified health center Corporate Officer Jan 1, 2001
JWCH Path ClinicLos Angeles, CA, CCN 921933 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - San Julian OasisLos Angeles, CA, CCN 921050 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - Zonal AveLos Angeles, CA, CCN 921052 Federally qualified health center Corporate Officer Jan 1, 2001
Wesley Health Centers - Health and Wellness Center 2Lancaster, CA, CCN A01174 Federally qualified health center Corporate Officer Jan 1, 2001

Owned or controlled facilities with NPI records 30

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 30

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476921600000",
    "number": "1417022336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8210 BELLGAVE PL",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900691601",
            "telephone_number": "213-706-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 S SAN PEDRO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900132102",
            "telephone_number": "213-486-4929",
            "fax_number": "213-627-4043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREGERSON",
        "first_name": "PAUL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2016-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G55695",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PPIN",
            "identifier": "WG55695A",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.