NPIMap

Organization Active NPI

Gage Medical Clinic Inc

  • General Practice Physician
  • Huntington Park, CA
National Provider Identifier
1477069375
Registry record updated Jan 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G29047 Issued in CA
Legal business name
GAGE MEDICAL CLINIC INC
Practice address
3203 E. Florence Ave.
Huntington Park, CA 90255-3008
Phone
(323) 835-6310
Fax
(323) 835-6382
NPI assigned
Dec 15, 2017
Organization subpart
Yes
Parent organization
GAGE MEDICAL CLINIC INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2018

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

Authorized official

Name
Richard C. Keech, M.D.NPI 1487748364
Title
Physician/Owner
Phone
(562) 699-2248

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X G29047 CA Primary

Addresses

Primary practice location

3203 E. Florence Ave.
Huntington Park, CA 90255-3008

Mailing address

3203 E. Florence Avenue
Huntington Park, CA 90255-3908
Phone (323) 835-6310

Other names 1

  • Mother Theresa Medical Center of Huntington Park Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220801001797 CA Part B Supplier - Clinic/Group Practice 0446632988 Receives reassigned benefits from 2 practitioners
Practice locations: Inglewood, CA; Los Angeles, CA; Huntington Park, CA

National Provider Directory

National Provider Directory
Tax ID family
Gage Medical Clinic Inc3 organizations share this tax ID, including this one
Part of
Gage Medical Clinic Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1513296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516838400000",
    "number": "1477069375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3203 E. FLORENCE AVENUE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902553908",
            "telephone_number": "323-835-6310",
            "fax_number": "323-835-6382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3203 E. FLORENCE AVE.",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902553008",
            "telephone_number": "323-835-6310",
            "fax_number": "323-835-6382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAGE MEDICAL CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GAGE MEDICAL CLINIC INC.",
        "enumeration_date": "2017-12-15",
        "last_updated": "2018-01-25",
        "status": "A",
        "authorized_official_last_name": "KEECH",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "562-699-2248",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "G29047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mother Theresa Medical Center of Huntington Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2018; 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.