Southland Renal Medical Group, Inc

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

A46344 Issued in CA

Legal business name

SOUTHLAND RENAL MEDICAL GROUP, INC

Practice address

2865 Atlantic Ave
Suite 101
Long Beach, CA 90806-1740

Phone

(562) 427-0350

Fax

(560) 630-3107

NPI assigned

Mar 13, 2007

Last updated

May 19, 2008By 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

Sandra Rodriguez

Title

Office Manager

Phone

(562) 630-3111

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Southland Renal Medical Group, Inc

  • Nephrology Physician
  • Fountain Valley, CA
  • NPI 1134252679

  O20050718001019

  Same enrollment
• Southland Renal Medical Group, Inc

  • Nephrology Physician
  • Long Beach, CA
  • NPI 1851589600

  O20050718001019

  Same enrollment
• Southland Renal Medical Group, Inc

  • Nephrology Physician
  • Downey, CA
  • NPI 1992838429

  O20050718001019

  Same enrollment
• Southland Renal Medical Group, Inc.

  • Nephrology Physician
  • Los Alamitos, CA
  • NPI 1205969748

  O20050718001019

  Same enrollment
• Southland Renal Medical Group, Inc.

  • Nephrology Physician
  • Long Beach, CA
  • NPI 1730110495

  O20050718001019

  Same enrollment

Practitioners 2

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.

• Ericson P Reyes

  • Nurse Practitioner
  • Lakewood, CA
  • NPI 1740397413
  NPD
• Avedik Semerjian, MD, FACP, FASN

  • Nephrology Physician
  • Lakewood, CA
  • NPI 1831120591
  NPD (past)

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1447383971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3650 SOUTH ST",
            "address_2": "SUITE 301",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121502",
            "telephone_number": "562-630-3111",
            "fax_number": "562-630-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 ATLANTIC AVE",
            "address_2": "SUITE 101",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061740",
            "telephone_number": "562-427-0350",
            "fax_number": "560-630-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND RENAL MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "562-630-3111"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A46344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0093372",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southland Neurologic Associates of Orange County Inc
• Southland Neurologic Institute
• Southland Neurologic Institute
• Southland Neurologic Institute
• Southland Neurologic Institute a Medical Corporation
• Southland Renal Medical Group, Inc
• Southland Renal Medical Group, Inc.
• Annabella Elizabeth Souza
• Jacob Souza
• Thirno Sow

• Nephrology Physician in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.