NPIMap

Organization Active NPI

Southland Neurologic Institute a Medical Corporation

  • Neurology Physician
  • Long Beach, CA
National Provider Identifier
1528498409
Registry record updated Nov 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
G20309 Issued in CA
Legal business name
SOUTHLAND NEUROLOGIC INSTITUTE A MEDICAL CORPORATION
Practice address
3747 Worsham Avenue
#100
Long Beach, CA 90808-1774
Phone
(562) 430-4513
Fax
(562) 430-7718
NPI assigned
Nov 14, 2013
Last updated
Nov 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2015

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

Authorized official

Name
Dr. Alan H Cohen, M.D.NPI 1902843659
Title
Ceo
Phone
(562) 430-4513

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084N0400X G20309 CA Primary

Addresses

Primary practice location

3747 Worsham Avenue
#100
Long Beach, CA 90808-1774

Mailing address

3747 Worsham Avenue
#100
Long Beach, CA 90808-1774
Phone (562) 430-4513

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160218001757 CA Part B Supplier - Clinic/Group Practice 0446555023 Receives reassigned benefits from 13 practitioners
Practice locations: Long Beach, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446508800000",
    "number": "1528498409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3747 WORSHAM AVENUE",
            "address_2": "#100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908081774",
            "telephone_number": "562-430-4513",
            "fax_number": "562-430-7718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3747 WORSHAM AVENUE",
            "address_2": "#100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908081774",
            "telephone_number": "562-430-4513",
            "fax_number": "562-430-7718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND NEUROLOGIC INSTITUTE A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-14",
        "last_updated": "2015-11-03",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-430-4513",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "G20309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; 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.