Individual provider Active NPI

Diane Marie Ferguson, M.D.

  • Internal Medicine Physician
  • Redondo Beach, CA
National Provider Identifier
1447294384
Registry record updated Nov 29, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G079787 Issued in CA
Practice address
502 Torrance Blvd
Redondo Beach, CA 90277-3413
Phone
(310) 792-3647
NPI assigned
Jun 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2021

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 G079787 CA Primary

Addresses

Primary practice location

502 Torrance Blvd
Redondo Beach, CA 90277-3413

Mailing address

3009 Walnut Ave
Manhattan Beach, CA 90266-2412
Phone (310) 418-3266

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
I20040823000788 CA Practitioner - Internal Medicine 9335113695 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

5300 McConnell Ave
Los Angeles, CA 90066-7026
Phone (833) 574-2273

6041 Cadillac Ave
Los Angeles, CA 90034-1702
Phone (800) 954-8000

Hospital & facility affiliations

  • Kaiser Foundation Hospital - West la Hospital, Los Angeles, CA, CCN 050561

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G079787CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 10, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 10, 2019 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

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

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1447294384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3009 WALNUT AVE",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902662412",
            "telephone_number": "310-418-3266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "502 TORRANCE BLVD",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902773413",
            "telephone_number": "310-792-3647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FERGUSON",
        "first_name": "DIANE",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G079787",
            "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": "6041 Cadillac Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900341702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Redondo Beach, CA

Sources for this page

Verify at the official NPI Registry.