NPIMap

Prohealth Partners a Medical Group Inc

Organization Active NPI Family Medicine Physician · Lakewood, CA

NPI 1588030951 · NPPES record last updated Aug 19, 2015

Key facts

NPI
1588030951
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
PROHEALTH PARTNERS A MEDICAL GROUP INC
Practice address
5750 Downey Ave
Suite 206
Lakewood, CA 90712-1405
Phone
(562) 384-3034
NPI assigned
Aug 19, 2015
Organization subpart
No

Authorized official

Name
Barry S Allswang, MD
Title
President
Phone
(562) 299-5200

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 5

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

  • Judy Chin, NP Family Nurse Practitioner · Beverly Hills, CA · NPI 1528763968
    NPD
  • Travis Desa, MD Interventional Cardiology Physician · Lakewood, CA · NPI 1902298219
    NPD
  • Jacqueline A Eubany, M.D. Clinical Cardiac Electrophysiology Physician · Orange, CA · NPI 1912986944
    NPD FAMILY MEDICINE
  • Cherie R Garcia, MD Internal Medicine Physician · Lakewood, CA · NPI 1497786396
    NPD
  • Marianne F Mikhail, MD Family Medicine Physician · Lakewood, CA · NPI 1164743464
    NPD FAMILY MEDICINE

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031211000927 CA Part B Supplier - Clinic/Group Practice 2769388412 Receives reassigned benefits from 296 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Prohealth Partners a M (63 organizations share this tax ID)

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD
    Plans: 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)…

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

5750 Downey Ave
Suite 206
Lakewood, CA 90712-1405

Mailing address

5150 E Pacific Coast Hwy
Suite 500
Long Beach, CA 90804-3312

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 19, 2015.

{
    "created_epoch": "1439942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1439942400000",
    "number": "1588030951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 E PACIFIC COAST HWY",
            "address_2": "SUITE 500",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908043312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 DOWNEY AVE",
            "address_2": "SUITE 206",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121405",
            "telephone_number": "562-384-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROHEALTH PARTNERS A MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-19",
        "last_updated": "2015-08-19",
        "status": "A",
        "authorized_official_last_name": "ALLSWANG",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-299-5200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CA

All providers in Lakewood, CA · Family Medicine Physician in California

Sources for this page

Verify at the official NPI Registry.