NPIMap

Organization Active NPI

Yacoub Medical, Inc.

Doing business as Doctors Urgent Care Medical Group

  • General Practice Physician
  • Montebello, CA
National Provider Identifier
1477698512
Registry record updated Nov 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
C35815 Issued in CA
Legal business name
YACOUB MEDICAL, INC.
Doing business as
Doctors Urgent Care Medical Group
Practice address
120 S Montebello Blvd
Montebello, CA 90640-4730
Phone
(323) 720-9204
Fax
(323) 720-9208
NPI assigned
Feb 20, 2007
Last updated
Nov 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2008

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

Authorized official

Name
Mr. Alex Yacoub
Title
Billing Office Manager
Phone
(323) 720-9204

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X C35815 CA Primary
General Practice Physician 208D00000X A40189 CA

Addresses

Primary practice location

120 S Montebello Blvd
Montebello, CA 90640-4730

Mailing address

120 S Montebello Blvd
Montebello, CA 90640-4730
Phone (323) 720-9204

Other identifiers 1

IdentifierTypeStateIssuer
GR0070010MedicaidCA

Other names 1

  • Doctors Urgent Care Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081208000595 CA Part B Supplier - Clinic/Group Practice 0446311542 Receives reassigned benefits from 7 practitioners
Practice locations: Montebello, CA

National Provider Directory

National Provider Directory
Tax ID family
Atef L Yacoub MD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

120 S Montebello Blvd
#A
Montebello, CA 90640

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226448000000",
    "number": "1477698512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 S MONTEBELLO BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404730",
            "telephone_number": "323-720-9204",
            "fax_number": "323-720-9208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S MONTEBELLO BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404730",
            "telephone_number": "323-720-9204",
            "fax_number": "323-720-9208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YACOUB MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2008-11-12",
        "status": "A",
        "authorized_official_last_name": "YACOUB",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "BILLING OFFICE MANAGER",
        "authorized_official_telephone_number": "323-720-9204",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "C35815",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A40189",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0070010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctors Urgent Care Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Montebello, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2008; 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.