NPIMap

Organization Active NPI

Simi Obstetrics & Gynecology Medical Group a Medical Corp.

  • Obstetrics & Gynecology Physician
  • Simi Valley, CA
National Provider Identifier
1487858932
Registry record updated Jul 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
SIMI OBSTETRICS & GYNECOLOGY MEDICAL GROUP A MEDICAL CORP.
Practice address
1147 Red Tail Way
Simi Valley, CA 93065-7232
Phone
(805) 527-8055
Fax
(805) 520-8849
NPI assigned
Jun 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2015

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

Authorized official

Name
Dr. Catherine Kim, MDNPI 1972596120
Title
Cfo
Phone
(805) 527-8055

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
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

1147 Red Tail Way
Simi Valley, CA 93065-7232

Mailing address

1147 Red Tail Way
Simi Valley, CA 93065-7232
Phone (805) 527-8055

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040720001367 CA Part B Supplier - Clinic/Group Practice 6305826561 Receives reassigned benefits from 7 practitioners
Practice locations: Simi Valley, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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": "1181520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437004800000",
    "number": "1487858932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 RED TAIL WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930657232",
            "telephone_number": "805-527-8055",
            "fax_number": "805-520-8849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1147 RED TAIL WAY",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930657232",
            "telephone_number": "805-527-8055",
            "fax_number": "805-520-8849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIMI OBSTETRICS & GYNECOLOGY MEDICAL GROUP A MEDICAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-11",
        "last_updated": "2015-07-16",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "805-527-8055",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Simi Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2015; 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.