Jon A Detterich, MD

Primary specialty

Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X

License

A89834 Issued in CA

Practice address

4650 W Sunset Blvd
Ms #113
Los Angeles, CA 90027-6062

Phone

(323) 361-2109

NPI assigned

Jan 9, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Cardiovascular Disease (Cardiology)

Education

Medical College of Wisconsin, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Childrens Hospital Los Angeles Medical Group IncGroup PAC ID 0143126920, 288 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Children'S Hospital Los Angeles Medical Group, Inc.

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
  • NPI 1265530653
  Medicare reassignment Care Compare group NPD
• Children'S Hospital Los Angeles

  • Children's Chronic Disease Hospital
  • Los Angeles, CA
  • NPI 1366527954
  NPD (past)
• Children'S Hospital Los Angeles Medical Group

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • Los Angeles, CA
  • NPI 1144428798
  NPD (past)
• Childrens Hospital of Los Angeles

  • Children's Hospital
  • Los Angeles, CA
  • NPI 1124073366
  NPD (past)

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

{
    "created_epoch": "1231459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231459200000",
    "number": "1659518884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6430 W SUNSET BLVD",
            "address_2": "SUITE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900287901",
            "telephone_number": "232-361-2337",
            "fax_number": "323-361-8491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 W SUNSET BLVD",
            "address_2": "MS #113",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276062",
            "telephone_number": "323-361-2109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTERICH",
        "first_name": "JON",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-09",
        "last_updated": "2009-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "CA",
            "license": "A89834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dawn Anne Desylvia, MD
• Nicholas Kenneth Detchman
• Determined Medical Inc
• Detox Treatment Center
• Zephyr Detrano
• Jina Vinh Dettman
• Alissa Anne Detz, MD
• Erika Deuel, OTR/L
• Catherine Marin Deugarte, M.D.
• Daniel Alberto Deugarte, MD

• Pediatric Emergency Medicine (Emergency Medicine) Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatric Emergency Medicine (Emergency Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2009; 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.