NPIMap

Organization Active NPI

Renal Medical Associates

  • Nephrology Physician
  • Lynwood, CA
National Provider Identifier
1609098003
Registry record updated Jan 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
Legal business name
RENAL MEDICAL ASSOCIATES
Practice address
3625 E Martin Luther King Jr Blvd #2
Lynwood, CA 90262
Phone
(310) 638-0533
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2013

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

Authorized official

Name
Samia A Khwaja, MD
Title
President
Phone
(310) 638-0533

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X Primary

Addresses

Primary practice location

3625 E Martin Luther King Jr Blvd #2
Lynwood, CA 90262

Mailing address

3625 E Martin Luther King Jr Blvd #2
Lynwood, CA 90262
Phone (310) 638-0533

Other identifiers 1

IdentifierTypeStateIssuer
GR0067120MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040903000898 CA Part B Supplier - Clinic/Group Practice 6305812066 Receives reassigned benefits from 3 practitioners
Practice locations: Lynwood, CA

National Provider Directory

National Provider Directory

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 & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359072000000",
    "number": "1609098003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3625 E MARTIN LUTHER KING JR BLVD #2",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "90262",
            "telephone_number": "310-638-0533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3625 E MARTIN LUTHER KING JR BLVD #2",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "90262",
            "telephone_number": "310-638-0533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENAL MEDICAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2013-01-25",
        "status": "A",
        "authorized_official_last_name": "KHWAJA",
        "authorized_official_first_name": "SAMIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-638-0533",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0067120",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynwood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2013; 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.