Organization Active NPI

Perpetual Mobile Medical Group Inc

  • Primary Care Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1457084386
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
PERPETUAL MOBILE MEDICAL GROUP INC
Practice address
5015 Eagle Rock Blvd Ste 200
Los Angeles, CA 90041-2087
Phone
(323) 455-4868
Fax
(323) 577-7826
NPI assigned
Jul 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

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

Authorized official

Name
Marlon Camar Salamat
Title
Cfo
Phone
(626) 497-6500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X
Primary Care Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

5015 Eagle Rock Blvd Ste 200
Los Angeles, CA 90041-2087

Mailing address

1200 E Route 66 Ste 102
Glendora, CA 91740-6360
Phone (323) 455-4868

Other practice location 1

1200 E Route 66 Ste 102
Glendora, CA 91740-6360
Phone (323) 455-4868

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.practicefusion.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments
Home infusion therapy
Medicare-enrolled home infusion therapy supplier

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20221115003383 CA Part B Supplier - Clinic/Group Practice 3779951165 Receives reassigned benefits from 7 practitioners
Practice locations: Los Angeles, CA
O20231019000440 CA Part B Supplier - Home Infusion Therapy Supplier 3779951165 Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

5015 Eagle Rock Blvd
Ste 202
Los Angeles, CA 90041

Practitioners & affiliated clinicians

Practitioners 7

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": "1657152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723507200000",
    "number": "1457084386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E ROUTE 66 STE 102",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917406360",
            "telephone_number": "323-455-4868",
            "fax_number": "323-577-7826"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5015 EAGLE ROCK BLVD STE 200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900412087",
            "telephone_number": "323-455-4868",
            "fax_number": "323-577-7826"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 E Route 66 Ste 102",
            "address_purpose": "LOCATION",
            "city": "Glendora",
            "state": "CA",
            "postal_code": "917406360",
            "country_code": "US",
            "telephone_number": "323-455-4868",
            "fax_number": "323-577-7826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PERPETUAL MOBILE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-07",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A",
        "authorized_official_last_name": "SALAMAT",
        "authorized_official_first_name": "MARLON",
        "authorized_official_middle_name": "CAMAR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "626-497-6500"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.practicefusion.com",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "5015 Eagle Rock Blvd Ste 200",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900412087",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2024; 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.