Imd Medical Group Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A61923 Issued in CA

Legal business name

IMD MEDICAL GROUP INC

Practice address

1234 N Vermont Ave
Los Angeles, CA 90029-1704

Phone

(213) 487-6867

Fax

(213) 487-6811

NPI assigned

Jun 4, 2006

Last updated

Dec 10, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Imad El Asmar, M.D.NPI 1912956525

Title

President

Phone

(213) 487-6867

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Imad Aziz El Asmar, MD

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1912956525
  Medicare reassignment NPD Authorized official
• Marnel C. Baradi, PA-C

  • Physician Assistant
  • Los Angeles, CA
  • NPI 1033410238
  Medicare reassignment
• Yoodiy A Gonzales, PA

  • Physician Assistant
  • Pomona, CA
  • NPI 1942366281
  NPD (past)
• Mayra A Silhy, PA

  • Medical Physician Assistant
  • Riverside, CA
  • NPI 1407128929
  NPD (past)

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

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449705600000",
    "number": "1508804006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 N VERMONT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900291704",
            "telephone_number": "213-487-6867",
            "fax_number": "213-487-6811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 N VERMONT AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900291704",
            "telephone_number": "213-487-6867",
            "fax_number": "213-487-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMD MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2015-12-10",
        "status": "A",
        "authorized_official_last_name": "EL ASMAR",
        "authorized_official_first_name": "IMAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "213-487-6867",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A89382",
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A61923",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0093890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2015; 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.