NPIMap

Organization Active NPI

Brookside Anesthesia Group

  • Anesthesiology Physician
  • Glendale, CA
National Provider Identifier
1669927810
Registry record updated Aug 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
BROOKSIDE ANESTHESIA GROUP
Practice address
200 S Louise St
200
Glendale, CA 91205-1637
Phone
(818) 696-0091
NPI assigned
Aug 17, 2016
Last updated
Aug 17, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2016

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

Authorized official

Name
Dr. Ernest Shmidt, MDNPI 1003037508
Title
Doctor
Phone
(818) 550-0900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

200 S Louise St
200
Glendale, CA 91205-1637

Mailing address

PO Box 5486
Orange, CA 92863-5486
Phone (818) 550-0900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161021001856 CA Part B Supplier - Clinic/Group Practice 0446538649 Receives reassigned benefits from 14 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

200 S Louise St
#200
Glendale, CA 91205
Phone (818) 696-0091

200 S Louise St
Ste 200
Glendale, CA 91205
Phone (818) 696-0091

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471392000000",
    "number": "1669927810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5486",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928635486",
            "telephone_number": "818-550-0900",
            "fax_number": "303-953-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 S LOUISE ST",
            "address_2": "200",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051637",
            "telephone_number": "818-696-0091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSIDE ANESTHESIA GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-17",
        "last_updated": "2016-08-17",
        "status": "A",
        "authorized_official_last_name": "SHMIDT",
        "authorized_official_first_name": "ERNEST",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "818-550-0900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.