Beverly Pediatric Medical Group, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G42466 Issued in CA

Legal business name

BEVERLY PEDIATRIC MEDICAL GROUP, INC.

Practice address

1417 W Beverly Blvd
Suite 102
Montebello, CA 90640-4123

Phone

(323) 728-3270

Fax

(323) 728-2141

NPI assigned

Sep 20, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Hector Nahun De la Rocha, M.D.NPI 1467483115

Title

President/Owner

Phone

(323) 728-3270

Specialties & licenses 1

Addresses

Other identifiers 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 2

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

• Hector Nahun De la Rocha, M.D.

  • Pediatrics Physician
  • Montebello, CA
  • NPI 1467483115
  NPD (past) Authorized official
• Chantel Marisa De la Rocha, M.D.

  • Pediatrics Physician
  • Montebello, CA
  • NPI 1154431419
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376438400000",
    "number": "1508963653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1417 W BEVERLY BLVD",
            "address_2": "SUITE 102",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404146",
            "telephone_number": "323-728-3270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1417 W BEVERLY BLVD",
            "address_2": "SUITE 102",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404123",
            "telephone_number": "323-728-3270",
            "fax_number": "323-728-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEVERLY PEDIATRIC MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2013-08-14",
        "status": "A",
        "authorized_official_last_name": "DE LA ROCHA",
        "authorized_official_first_name": "HECTOR",
        "authorized_official_middle_name": "NAHUN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "323-728-3270",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G42466",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0013040",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beverly Hospitalist Group Incorporated
• Beverly Internal Medicine Medical Group Inc.
• Beverly Oncology & Imaging Center Medical GR
• Beverly Orthopedic Laboratory Inc
• Beverly Orthopedic Physical Therapy Center Inc.
• Beverly Plaza RX Inc
• Beverly Plaza RX Inc
• Beverly Professional Pharmacy
• Beverly Urgent Care Inc
• Beverlycare

• Pediatrics Physician in Montebello, CA
• Providers in Montebello, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.