Imperial Primary Care Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A61645 Issued in CA

Legal business name

IMPERIAL PRIMARY CARE MEDICAL GROUP

Practice address

15625 Imperial Hwy
La Mirada, CA 90638

Phone

(562) 902-3000

Fax

(562) 902-9563

NPI assigned

Mar 1, 2007

Organization subpart

No

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

Authorized official

Name

Jamshid Maleki, MDNPI 1407879646

Title

President

Phone

(562) 902-3000

Specialties & licenses 2

Addresses

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)…

Interoperability endpoints

• FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10008746

Practitioners 7

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

• Amine Rabah Chahbouni, D.O.

  • Family Medicine Physician
  • Irvine, CA
  • NPI 1326319021
  Medicare reassignment Care Compare group NPD
• Jose Ricardo Dalprat, D.O.

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1013299627
  Medicare reassignment Care Compare group NPD
• Marcus Wesley Lum, MD

  • Family Medicine Physician
  • La Mirada, CA
  • NPI 1003839242
  Medicare reassignment Care Compare group NPD
• Jamshid Maleki, M.D.

  • General Practice Physician
  • Tustin, CA
  • NPI 1407879646
  Medicare reassignment NPD Authorized official
• Rafael Rubalcava, MD

  • Family Medicine Physician
  • La Mirada, CA
  • NPI 1417978644
  Medicare reassignment Care Compare group NPD
• Michael O Roach, MD

  • Geriatric Medicine (Family Medicine) Physician
  • La Mirada, CA
  • NPI 1417970583

  Internal Medicine

  Medicare reassignment NPD
• Jamie Kehaulani Humphries Widger, PA-C

  • Physician Assistant
  • La Mirada, CA
  • NPI 1053185918
  Medicare reassignment

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

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534204800000",
    "number": "1598893455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15034 IMPERIAL HWY",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "906381301",
            "telephone_number": "562-902-3000",
            "fax_number": "562-902-9563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15625 IMPERIAL HWY",
            "city": "LA MIRADA",
            "state": "CA",
            "postal_code": "90638",
            "telephone_number": "562-902-3000",
            "fax_number": "562-902-9563"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL PRIMARY CARE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-01",
        "last_updated": "2018-08-14",
        "status": "A",
        "authorized_official_last_name": "MALEKI",
        "authorized_official_first_name": "JAMSHID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-902-3000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A61645",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G32190",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hee Hur
• Sora Hwang
• Annette Hwangbo, LCSW
• Chiagoziem Igweze, RN
• Olisaemeka Arinzechukwu Igweze
• Intercommunity Dialysis Center-la Mirada
• J & S Management Services LLC
• Tiffany Hope Jackson
• Hyejin Jae, M.D.
• Keith Jamieson, MD

• Family Medicine Physician in La Mirada, CA
• Providers in La Mirada, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; 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.