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Prohealth Partners a Medical Group Inc

Organization Active NPI Psychiatry Physician · Costa Mesa, CA

NPI 1639613359 · NPPES record last updated Apr 19, 2018

Key facts

NPI
1639613359
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
Legal business name
PROHEALTH PARTNERS A MEDICAL GROUP INC
Practice address
2900 Bristol St Ste B203
Costa Mesa, CA 92626-5948
Phone
(855) 867-5551
Fax
(562) 594-8557
NPI assigned
Dec 14, 2016
Organization subpart
No

Authorized official

Name
Barry Steven 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 3

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2287704Prohealth Partners a Medical Group Inc
2900 Bristol St Building B205, Costa Mesa, CA 92626		Certificate of waiverAug 15, 2027

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
Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0800X Yes

Addresses

Primary practice location

2900 Bristol St Ste B203
Costa Mesa, CA 92626-5948

Mailing address

2900 Bristol St # B203B205
Costa Mesa, CA 92626-5981
Phone (855) 867-5551

Other practice location 1

20311 SW Birch St Ste 100
Newport Beach, CA 92660-1778
Phone (949) 281-6149

Other providers in Costa Mesa, CA

All providers in Costa Mesa, CA · Psychiatry Physician in California

Sources for this page

Verify at the official NPI Registry.