Organization Active NPI

Jorge L Moran MD Inc

  • General Practice Physician
  • Inglewood, CA
National Provider Identifier
1487795753
Registry record updated Mar 9, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A63662 Issued in CA
Legal business name
JORGE L MORAN MD INC
Practice address
210 S Locust St
Inglewood, CA 90301-2304
Phone
(310) 673-9920
Fax
(310) 673-9919
NPI assigned
Feb 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2018

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

Authorized official

Name
Jorge L Moran, MDNPI 1699790667
Title
President
Phone
(310) 673-9920

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: 193400000X SINGLE SPECIALTY GROUP 208D00000X A63662 CA Primary

Addresses

Primary practice location

210 S Locust St
Inglewood, CA 90301-2304

Mailing address

210 S Locust St
Inglewood, CA 90301-2304
Phone (310) 673-9920

Other identifiers 1

IdentifierTypeStateIssuer
00A636620MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071023000803 CA Part B Supplier - Clinic/Group Practice 3870689730 Receives reassigned benefits from 1 practitioner
Practice locations: Inglewood, CA

National Provider Directory

National Provider Directory

Locations

210 S Locust St
Inglewood, CA 90301
Phone (213) 481-1241

4635 W Century Blvd
Inglewood, CA 90304
Phone (310) 673-9920

12340 Santa Monica Blvd
Ste 101
Los Angeles, CA 90025
Phone (310) 458-1259

Practitioners & affiliated clinicians

Practitioners 6

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": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520553600000",
    "number": "1487795753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S LOCUST ST",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903012304",
            "telephone_number": "310-673-9920",
            "fax_number": "310-673-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S LOCUST ST",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903012304",
            "telephone_number": "310-673-9920",
            "fax_number": "310-673-9919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORGE L MORAN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2018-03-09",
        "status": "A",
        "authorized_official_last_name": "MORAN",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-673-9920",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A63662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A636620",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 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.