NPIMap

Organization Active NPI

Prohealth Partners a Medical Group Inc

  • Psychiatry Physician
  • Costa Mesa, CA
National Provider Identifier
1639613359
Registry record updated Apr 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 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
Last updated
Apr 19, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2018

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

Authorized official

Name
Barry Steven Allswang, MD
Title
President
Phone
(562) 299-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

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

Medicare participation

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

Enrollment records 1

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2287704Prohealth Partners a Medical Group Inc2900 Bristol St Building B205, Costa Mesa, CA 92626Certificate of waiverAug 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Prohealth Part Ner63 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524096000000",
    "number": "1639613359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2900 BRISTOL ST # B203B205",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265981",
            "telephone_number": "855-867-5551",
            "fax_number": "949-209-1981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 BRISTOL ST STE B203",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926265948",
            "telephone_number": "855-867-5551",
            "fax_number": "562-594-8557"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20311 SW Birch St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926601778",
            "country_code": "US",
            "telephone_number": "949-281-6149",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROHEALTH PARTNERS A MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-14",
        "last_updated": "2018-04-19",
        "status": "A",
        "authorized_official_last_name": "ALLSWANG",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-299-5200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 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.