Omnicare Medical Group, Inc

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

OMNICARE MEDICAL GROUP, INC

Practice address

3680 E Imperial Hwy
Suite 480
Lynwood, CA 90262-2659

Phone

(310) 605-0000

Fax

(310) 605-0051

NPI assigned

Oct 2, 2007

Organization subpart

Yes

Parent organization

OMNICARE MEDICAL GROUP, INCAs reported in NPPES

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

Authorized official

Name

Toni Johnson-Chavis, MD

Title

Chief Executive Officer

Phone

(310) 605-0000

Specialties & licenses 1

Addresses

Part of

Omnicare Medical Group Inc

Locations

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)…

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Daria Jacob, RDN

  • Registered Dietitian
  • Hollywood, CA
  • NPI 1194486746
  NPD (past)
• Hazel NG, R.D.

  • Registered Dietitian
  • San Gabriel, CA
  • NPI 1750321634
  NPD (past)
• Magnolia Vela

  • Registered Dietitian
  • Long Beach, CA
  • NPI 1083795231
  NPD (past)

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191283200000",
    "number": "1457548604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3680 E IMPERIAL HWY",
            "address_2": "SUITE 480",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622659",
            "telephone_number": "310-605-0000",
            "fax_number": "310-605-0051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 E IMPERIAL HWY",
            "address_2": "SUITE 480",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622659",
            "telephone_number": "310-605-0000",
            "fax_number": "310-605-0051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNICARE MEDICAL GROUP, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OMNICARE MEDICAL GROUP, INC",
        "enumeration_date": "2007-10-02",
        "last_updated": "2007-10-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON-CHAVIS",
        "authorized_official_first_name": "TONI",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "310-605-0000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elsa Olivera Diaz
• Crystal Hope Olivo
• Matthew Olufemi Egbedi
• Rebeca Ana Olvera
• Bassam Omari, M.D.
• One Health Medical
• One Health Medical Group Inc
• Kenechukwu Oranusi, NP-BC
• David Oronoz
• Jose Miguel Oropeza Paredes

• All providers in Lynwood, CA
• Health Maintenance Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; 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.