Illuminary Medical Group, PC

Primary specialty

Hospitalist PhysicianTaxonomy code 208M00000X

Legal business name

ILLUMINARY MEDICAL GROUP, PC

Doing business as

Illuminary Medical Group, PC

Practice address

2623 E Slauson Ave
Huntington Park, CA 90255-2926

Phone

(323) 583-1931

NPI assigned

May 7, 2020

Last updated

May 7, 2020By 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

Jim Seraj, M.D.NPI 1467746362

Title

Chief Executive Officer

Phone

(949) 295-0342

Specialties & licenses 1

Addresses

Other names 1

• Illuminary Medical Group, PC Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

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.

• Jim Sorena Seraj, M.D.

  • Emergency Medicine Physician
  • Winchester, CA
  • NPI 1467746362
  Medicare reassignment NPD Authorized official
• Matthew Hakimi, MD

  • Clinical Cardiac Electrophysiology Physician
  • Ventura, CA
  • NPI 1639433246

  Hospitalist

  Medicare reassignment NPD

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

{
    "created_epoch": "1588809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588809600000",
    "number": "1487276812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4419",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913654419",
            "telephone_number": "818-340-9988",
            "fax_number": "818-936-0427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2623 E SLAUSON AVE",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552926",
            "telephone_number": "323-583-1931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4060 Whittier Blvd",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900232526",
            "country_code": "US",
            "telephone_number": "323-268-5514",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13100 Studebaker Rd",
            "address_purpose": "LOCATION",
            "city": "Norwalk",
            "state": "CA",
            "postal_code": "906502500",
            "country_code": "US",
            "telephone_number": "562-868-3751",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ILLUMINARY MEDICAL GROUP, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-07",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A",
        "authorized_official_last_name": "SERAJ",
        "authorized_official_first_name": "JIM",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "949-295-0342",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Illuminary Medical Group, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Hospitalist Physician in Huntington Park, CA
• Providers in Huntington Park, CA by specialty
• Hospitalist Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; 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.