Cardiology Practice Medical Group

Primary specialty

SpecialistTaxonomy code 174400000X

License

A33230 Issued in CA

Legal business name

CARDIOLOGY PRACTICE MEDICAL GROUP

Practice address

17075 Devonshire St Ste 201
Northridge, CA 91325-5407

Phone

(818) 365-9595

Fax

(818) 365-8955

NPI assigned

Dec 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Richard Fernando Pego, M.D.

Title

President

Phone

(818) 365-9595

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276560000000",
    "number": "1629132535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE ST STE 201",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255407",
            "telephone_number": "818-365-9595",
            "fax_number": "818-365-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE ST STE 201",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255407",
            "telephone_number": "818-365-9595",
            "fax_number": "818-365-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIOLOGY PRACTICE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2010-06-15",
        "status": "A",
        "authorized_official_last_name": "PEGO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "FERNANDO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-365-9595",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A33230",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "222031992",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "060067979",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0091580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Northridge, CA
• Providers in Northridge, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.