Endoscopy Center of Southern California LLC

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

Legal business name

ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA LLC

Doing business as

Endoscopy Center of Southern California

Practice address

2336 Santa Monica Blvd Ste 204
Santa Monica, CA 90404-2938

Phone

(310) 453-4477

Fax

(310) 315-0204

NPI assigned

Jul 8, 2006

Organization subpart

No

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

Authorized official

Name

Eric Boon

Title

Ao

Phone

(480) 567-0269

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Endoscopy Center of Southern California Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Southern California Medical Gastroenterology Group IncCCN 05C0001193

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Ability Network2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Southern California Medical Gastroenterology Group, Inc

  • Ambulatory Surgical Clinic/Center
  • Los Angeles, CA
  • NPI 1093800492
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• VHS San Antonio Partners LLC

  • Psychiatric Hospital Unit
  • San Antonio, TX
  • NPI 1487633509

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Debra Hawk, CRNA

  • Certified Registered Nurse Anesthetist
  • Downey, CA
  • NPI 1437194461
  NPD (past)

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726531200000",
    "number": "1497788145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2336 SANTA MONICA BLVD",
            "address_2": "SUITE #204",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042095",
            "telephone_number": "310-829-6789",
            "fax_number": "310-315-0204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2336 SANTA MONICA BLVD STE 204",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042938",
            "telephone_number": "310-453-4477",
            "fax_number": "310-315-0204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDOSCOPY CENTER OF SOUTHERN CALIFORNIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A",
        "authorized_official_last_name": "BOON",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "480-567-0269"
    },
    "taxonomies": [
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01193F",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Endoscopy Center of Southern California",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Endoscopy Center of Southern California",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexandra Emmons, PSY.D.
• Emocean a Licensed Clinical Social Worker Corporation
• Emperor'S College of Traditional Oriental Medicine
• Shantaisha Kehaulani Enay
• Endo Anesthesia Services, Inc
• Charissa Endow, OTR/L
• Attara Enerva
• Jamie Soo Moi Eng, MD
• Cathy Annette Engel
• Vivian Engelsen

• Endoscopy Clinic/Center in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Endoscopy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.