NPIMap

Organization Active NPI

Peninsula Primary Care

  • Primary Care Clinic/Center
  • Torrance, CA
National Provider Identifier
1417673328
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
PENINSULA PRIMARY CARE
Practice address
5003 Pacific Coast Hwy
Torrance, CA 90505-5441
Phone
(877) 782-0300
NPI assigned
Oct 13, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

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

Authorized official

Name
Omer Deen, MDNPI 1417123332
Title
Owner
Phone
(310) 994-9903

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X Primary

Addresses

Primary practice location

5003 Pacific Coast Hwy
Torrance, CA 90505-5441

Mailing address

5003 Pacific Coast Hwy
Torrance, CA 90505-5441

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230721001188 CA Part B Supplier - Clinic/Group Practice 3072973007 Receives reassigned benefits from 8 practitioners
Practice locations: Torrance, CA

National Provider Directory

National Provider Directory

Locations

5001 Pacific Coast Hwy
Torrance, CA 90505
Phone (310) 994-9903

5003 Pacific Coast Hwy
Torrance, CA 90505
Phone (877) 782-0300

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1417673328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5003 PACIFIC COAST HWY",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905055441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5003 PACIFIC COAST HWY",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905055441",
            "telephone_number": "877-782-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA PRIMARY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-13",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "DEEN",
        "authorized_official_first_name": "OMER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-994-9903",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.