Peolia Kansas Fonsworth III, M.D., M.B.A

Primary specialty

Addiction Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084A0401X

License

A132680 Issued in CA

Practice address

1000 W Carson St
Torrance, CA 90502-2004

Phone

(310) 222-2345

NPI assigned

Apr 3, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

University of California, Irvine, California College of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Martin Luther King Jr Community Medical FoundationGroup PAC ID 8628359502, 193 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Martin Luther King, Jr. Community Hospital Hospital, Los Angeles, CA, CCN 050779

Merit-based Incentive Payment System (MIPS)

Final score

93.78 of 100Reported as apm

Quality

80.38

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Business Administration, Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: pfonsworth@direct.mlkch.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Martin Luther King Jr Community Medical Foundation

  dba Martin Lurher King Jr. Community Medical Group

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1356899777
  Medicare reassignment Care Compare group NPD
• Martin Luther King Jr Community Medical Foundation

  • Radiology Clinic/Center
  • Los Angeles, CA
  • NPI 1346082294
  NPD
• Martin Luther King Jr Community Medical Foundation

  dba Martin Luther King Jr. Community Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1639704323
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Martin Luther King, Jr. - Los Angeles (MLK-la) Healthcare Corporation

  dba Martin Luther King, Jr. Community Hospital

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1114367497
  Care Compare affiliation

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1639412091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 W CARSON ST",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905022004",
            "telephone_number": "415-240-5467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 W CARSON ST",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905022004",
            "telephone_number": "310-222-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONSWORTH",
        "first_name": "PEOLIA",
        "middle_name": "KANSAS",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D., M.B.A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-04-03",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A132680",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084A0401X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Medicine",
            "state": "CA",
            "license": "A132680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pfonsworth@direct.mlkch.org",
            "affiliation": "N",
            "address_1": "12021 Wilmington Ave.",
            "address_2": "Bldg 11 STE. 1000",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900593019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Margaret Fong, PHARM.D.
• Sarah Fong, D.O.
• Andres Fonseca, NP
• Briana Jasmine Fonseca
• Encanto Fonseca
• Angelique Fontaine
• For Eyes Optical of California, Inc (For Eyes Optical)
• Joseph Ford, M.D.
• Kimberly Marie Ford, MA, OTR
• Natasha Ford

• Addiction Medicine (Psychiatry & Neurology) Physician in Torrance, CA
• Providers in Torrance, CA by specialty
• Addiction Medicine (Psychiatry & Neurology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.