Organization Active NPI

Golden State Bone and Joint Clinic

  • Orthopaedic Surgery Physician
  • Beverly Hills, CA
National Provider Identifier
1508139957
Registry record updated May 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
A100628 Issued in CA
Legal business name
GOLDEN STATE BONE AND JOINT CLINIC
Practice address
9033 Wilshire Blvd
Suite 403
Beverly Hills, CA 90210-1847
Phone
(310) 858-3800
Fax
(888) 589-6241
NPI assigned
Feb 15, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2013

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

Authorized official

Name
Matthew J. Enna, MDNPI 1396797809
Title
Owner
Phone
(310) 858-3880

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X A100628 CA Primary
Orthopaedic Hand Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XS0106X A100628 CA
Sports Medicine (Orthopaedic Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207XX0005X A100628 CA

Addresses

Primary practice location

9033 Wilshire Blvd
Suite 403
Beverly Hills, CA 90210-1847

Mailing address

9033 Wilshire Blvd
Suite 403
Beverly Hills, CA 90210-1847
Phone (310) 858-3800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120220000314 CA Part B Supplier - Clinic/Group Practice 4789842972 Receives reassigned benefits from 3 practitioners
Practice locations: Marina del Rey, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369094400000",
    "number": "1508139957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9033 WILSHIRE BLVD",
            "address_2": "SUITE 403",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902101847",
            "telephone_number": "310-858-3800",
            "fax_number": "888-589-6241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9033 WILSHIRE BLVD",
            "address_2": "SUITE 403",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902101847",
            "telephone_number": "310-858-3800",
            "fax_number": "888-589-6241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOLDEN STATE BONE AND JOINT CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2013-05-21",
        "status": "A",
        "authorized_official_last_name": "ENNA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-858-3880",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "A100628",
            "primary": true
        },
        {
            "code": "207XS0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Hand Surgery",
            "state": "CA",
            "license": "A100628",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "A100628",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; 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.