Hawthorne Morningside Medical Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A82810 Issued in CA

Legal business name

HAWTHORNE MORNINGSIDE MEDICAL CLINIC

Practice address

12954 Hawthorne Blvd
Suite 104
Hawthorne, CA 90250-4418

Phone

(310) 679-0269

Fax

(310) 679-1038

NPI assigned

Feb 6, 2007

Last updated

Dec 13, 2011By 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

Dr. Lemmon McMillan, MD

Title

Owner

Phone

(310) 901-4714

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 5

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.

• John K Liu, MD

  • Physical Medicine & Rehabilitation Physician
  • Huntington Park, CA
  • NPI 1194739797

  Internal Medicine

  Medicare reassignment NPD
• Jessica Cruze, FNP-BC

  • Family Nurse Practitioner
  • Hawthorne, CA
  • NPI 1477376309
  NPD (past)
• Elizabeth Ibarra, MSN, FNP-C

  • Family Nurse Practitioner
  • Hawthorne, CA
  • NPI 1740726850
  NPD (past)
• Ololade Olamide Obafemi, NP

  • Primary Care Nurse Practitioner
  • Hawthorne, CA
  • NPI 1669993358
  NPD (past)
• Potenciano Reynoso Paredes, M.D.

  • Pediatrics Physician
  • Los Angeles, CA
  • NPI 1104856335
  NPD (past)

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

{
    "created_epoch": "1170720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1477692408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12954 HAWTHORNE BLVD",
            "address_2": "SUITE 104",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902504418",
            "telephone_number": "310-679-0269",
            "fax_number": "310-679-1038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12954 HAWTHORNE BLVD",
            "address_2": "SUITE 104",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902504418",
            "telephone_number": "310-679-0269",
            "fax_number": "310-679-1038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HAWTHORNE MORNINGSIDE MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-06",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "MCMILLAN",
        "authorized_official_first_name": "LEMMON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-901-4714",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G77541",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A82810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0092930",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shazia Mahmood Hasan, M.D.
• Carrie Hawkins, P.A.
• Hawthorne Academy
• Hawthorne Elementary School District
• Hawthorne Healthcare & Wellness Centre, LP
• Hawthorne Terrace Care Home
• Hayward L Eubanks M D a Medical Corporation
• Healing Hands Home Care LLC
• Health Care Partners, Inc.
• Hedieh Hashemi DDS PC

• Pediatrics Physician in Hawthorne, CA
• Providers in Hawthorne, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.