Lysander Jim, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

A124122 Issued in CA

Practice address

452 N Altadena Dr Unit 200
Pasadena, CA 91107-2536

Phone

(626) 838-5485

NPI assigned

Apr 20, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Lysander Jim, M.D. Inc

  • Clinic/Center
  • Pasadena, CA
  • NPI 1639619414
  NPD Authorized official

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

{
    "created_epoch": "1303257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490054400000",
    "number": "1457642795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 CAMINO VERDE",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910304139",
            "telephone_number": "626-297-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 N ALTADENA DR UNIT 200",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911072536",
            "telephone_number": "626-838-5485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIM",
        "first_name": "LYSANDER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-20",
        "last_updated": "2017-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A124122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryan S. Jick, MD
• Marina Jick, NP
• Jie Shi Yan MD Inc (Gordy Health)
• Shahe N Jierian, PHD
• Jigar Kadakia MD Inc
• Juan Jimenez-Lopez
• Danielle A. Jimenez-Munoz, LMFT
• Angelica Monique Jimenez
• Cassandra Jimenez, M.S LMFT
• Dennien Jimenez

• Physical Medicine & Rehabilitation Physician in Pasadena, CA
• Providers in Pasadena, 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 Mar 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.