Boulevard Medical Group, Inc.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

BOULEVARD MEDICAL GROUP, INC.

Doing business as

Prohealth Physical Medicine

Practice address

11239 Ventura Blvd Ste 213
Studio City, CA 91604-3167

Phone

(818) 505-0152

Fax

(818) 505-0398

NPI assigned

Sep 25, 2014

Last updated

Oct 23, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Robert Gonzalez, D.C.

Title

President

Phone

(818) 505-0152

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Prohealth Physical Medicine Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 6

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.

• Garrett G Glapa, NP

  • Acute Care Nurse Practitioner
  • Studio City, CA
  • NPI 1538448949
  Medicare reassignment Care Compare group NPD
• Abraham Hershel Grosswasser, D.C.

  • Chiropractor
  • Los Angeles, CA
  • NPI 1326487844
  Medicare reassignment Care Compare group NPD
• Larry T. Halem, M.D.

  • Emergency Medicine Physician
  • Santa Monica, CA
  • NPI 1568574937
  Medicare reassignment NPD
• James Matthew Vangrinsven, D.C.

  • Chiropractor
  • Newhall, CA
  • NPI 1750401089
  Medicare reassignment NPD
• Cassandra Pallotto, PA-C

  • Physician Assistant
  • Palmdale, CA
  • NPI 1578952057
  Medicare reassignment
• Ryan Michael Greene, DO, MS

  • Sports Medicine (Preventive Medicine) Physician
  • Los Angeles, CA
  • NPI 1881089910
  NPD

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

{
    "created_epoch": "1411603200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445558400000",
    "number": "1437551033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11239 VENTURA BLVD STE 213",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916043167",
            "telephone_number": "818-505-0152",
            "fax_number": "818-505-0398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11239 VENTURA BLVD STE 213",
            "city": "STUDIO CITY",
            "state": "CA",
            "postal_code": "916043167",
            "telephone_number": "818-505-0152",
            "fax_number": "818-505-0398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-25",
        "last_updated": "2015-10-23",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-505-0152",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DME PTAN",
            "identifier": "CB236695",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prohealth Physical Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lou Bigelow, PHD
• Ellen Bloch, LCSW
• Kelli Blumberg
• Biana Bochkur, PSYD
• Bokchi Acu-Herb Center
• Boulevard Therapy
• Nicole Bradshaw, L. AC.
• Kulwinder Brar
• Jennifer Brizuela, LCSW
• Alisha Rene Brown, MS, MED, BCBA

• Physical Medicine & Rehabilitation Physician in Studio City, CA
• Providers in Studio City, CA by specialty
• Physical Medicine & Rehabilitation Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.