Organization Active NPI

Premier Neurology Medical Group Inc

  • Neurology Physician
  • Beverly Hills, CA
National Provider Identifier
1508160664
Registry record updated Mar 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
A50944 Issued in CA
Legal business name
PREMIER NEUROLOGY MEDICAL GROUP INC
Practice address
415 N Crescent Dr
Ste 110
Beverly Hills, CA 90210
Phone
(818) 307-0074
Fax
(310) 432-2889
NPI assigned
Jan 4, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2024

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

Authorized official

Name
Joann Pecoraro
Title
Biz MGR
Phone
(818) 307-0074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084N0400X A50944 CA Primary

Addresses

Primary practice location

415 N Crescent Dr
Ste 110
Beverly Hills, CA 90210

Mailing address

415 N Crescent Dr
Ste 110
Beverly Hills, CA 90210
Phone (818) 307-0074

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110302000686 CA Part B Supplier - Clinic/Group Practice 6709067390 Receives reassigned benefits from 1 practitioner
Practice locations: Beverly Hills, CA; Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

333 S Arroyo Pkwy
Ste 200
Pasadena, CA 91105

Practitioners & affiliated clinicians

Practitioners 1

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": "1294099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709769600000",
    "number": "1508160664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N CRESCENT DR",
            "address_2": "STE 110",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "90210",
            "telephone_number": "818-307-0074",
            "fax_number": "310-432-2889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N CRESCENT DR",
            "address_2": "STE 110",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "90210",
            "telephone_number": "818-307-0074",
            "fax_number": "310-432-2889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER NEUROLOGY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-04",
        "last_updated": "2024-03-07",
        "certification_date": "2020-05-04",
        "status": "A",
        "authorized_official_last_name": "PECORARO",
        "authorized_official_first_name": "JOANN",
        "authorized_official_title_or_position": "BIZ MGR",
        "authorized_official_telephone_number": "818-307-0074"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A50944",
            "primary": true
        }
    ],
    "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 Mar 7, 2024; 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.