Individual provider Active NPI

Maggie Lizardi Weiss, NP

  • Obstetrics & Gynecology Nurse Practitioner
  • Los Angeles, CA
National Provider Identifier
1659666048
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
20396 Issued in CA
Practice address
4900 W Sunset Blvd # 5B
Los Angeles, CA 90027-5814
Phone
(323) 783-6922
NPI assigned
Jun 14, 2011
Last updated
Nov 18, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 20396 CA Primary

Addresses

Primary practice location

4900 W Sunset Blvd # 5B
Los Angeles, CA 90027-5814

Mailing address

4900 W Sunset Blvd # 5B
Los Angeles, CA 90027-5814
Phone (323) 783-6922

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111013000127 CA Practitioner - Nurse Practitioner 9133390065 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
20396CAMDMental Health Occupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Feb 19, 2013 Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 19, 2013 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

4760 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-0567

4900 W Sunset Blvd
#5B
Los Angeles, CA 90027
Phone (323) 783-6922

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1308009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1659666048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 W SUNSET BLVD # 5B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275814",
            "telephone_number": "323-783-6922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 W SUNSET BLVD # 5B",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900275814",
            "telephone_number": "323-783-6922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISS",
        "first_name": "MAGGIE",
        "middle_name": "LIZARDI",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-14",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "CA",
            "license": "20396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4760 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.