Peninsula Anesthesia Group, Inc.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

Legal business name

PENINSULA ANESTHESIA GROUP, INC.

Practice address

1300 W 7TH St
San Pedro, CA 90732-3505

Phone

(310) 832-3311

NPI assigned

Apr 24, 2006

Organization subpart

No

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

Authorized official

Name

Maurice L. Gross, M.D.

Title

President

Phone

(310) 406-3760

Specialties & licenses 3

Addresses

Other identifiers 1

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)…

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1427014091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4331",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903094331",
            "telephone_number": "310-406-3760",
            "fax_number": "310-303-7944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 W 7TH ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907323505",
            "telephone_number": "310-832-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA ANESTHESIA GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-24",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "MAURICE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-406-3760",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ64632Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Juliette Peat
• Melissa Frances Pedersen, MFT
• Brandon Louis Pena
• Michelle L Penfold
• Hsiao P Peng, D.D.S.
• Peninsula Eyecare Medical Associates
• Peninsula Outpatient Surgery Center, Inc.
• Peninsula Pharmacy
• Vicki Penny, NP
• Blair Phillip Peoples, M.D.

• Anesthesiology Physician in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; 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.