Eastside Family Medical Associates, Inc.

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

EASTSIDE FAMILY MEDICAL ASSOCIATES, INC.

Doing business as

Eastside Family Clinic

Practice address

321 S Mednik Ave
Los Angeles, CA 90022-1839

Phone

(323) 261-4706

Fax

(323) 261-4124

NPI assigned

Aug 30, 2007

Last updated

Mar 29, 2022By 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

Dr. Enrique J. Gonzalez, M.D.NPI 1023161684

Title

President

Phone

(323) 261-4706

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Eastside Family Clinic Doing business as

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

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.

• Enrique Jose Gonzalez, M.D.

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1023161684
  Medicare reassignment NPD Authorized official
• Teresa Sifuentes Ortiz, FNP

  • Chore Provider
  • Los Angeles, CA
  • NPI 1073665998
  Medicare reassignment NPD
• Mary Divine Grace Dinsay Painaga, FNP

  • Family Nurse Practitioner
  • Downey, CA
  • NPI 1619528403
  Medicare reassignment NPD
• Jaime Armando Martinez

  • Physician Assistant
  • Los Angeles, CA
  • NPI 1821398116
  Medicare reassignment

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648512000000",
    "number": "1568656791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 S MEDNIK AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900221839",
            "telephone_number": "323-261-4706",
            "fax_number": "323-262-6874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 S MEDNIK AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900221839",
            "telephone_number": "323-261-4706",
            "fax_number": "323-261-4124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE FAMILY MEDICAL ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-30",
        "last_updated": "2022-03-29",
        "certification_date": "2022-03-29",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ENRIQUE",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-261-4706",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "G74790",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G747901",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eastside Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Multi-Specialty Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2022; 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.