NPIMap

Individual provider Active NPI

Modupe A. Aiyegbusi, M.D.

  • Family Medicine Physician
  • Torrance, CA
National Provider Identifier
1710088349
Registry record updated Mar 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A65390 Issued in CA
Practice address
21350 Hawthorne Blvd
Suite 157
Torrance, CA 90503-5605
Phone
(310) 540-7240
Fax
(310) 540-7280
NPI assigned
Sep 26, 2006
Last updated
Mar 23, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A65390 CA Primary

Addresses

Primary practice location

21350 Hawthorne Blvd
Suite 157
Torrance, CA 90503-5605

Mailing address

3661 Torrance Blvd
Ste 103
Torrance, CA 90503-4887
Phone (310) 540-7240

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050429000597 CA Practitioner - Family Practice 9335053214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3661 Torrance Blvd
Suite 103
Torrance, CA 90503-4887
Phone (310) 540-7240

3801 Katella Ave
Los Alamitos, CA 90720-3396

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A65390CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Partners, a Medical Group Current Accepting new patients
Prohealth Partners a Medical Group CurrentSince Feb 1, 2023 Accepting new patients
Prohealth Partners, a Medical Group, Inc. CurrentSince Feb 1, 2023 Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Prime Healthcare Centinela, LLC Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Healthcare Partners Affiliates Medical Group Family Medicine Past Accepting new patients
Torrance Memorial Medical Center Past Accepting new patients
Providence Health System Southern California Past Accepting new patients

Locations

3801 Katella Ave
Ste 330
Los Alamitos, CA 90720
Phone (562) 594-9546

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

3661 Torrance Blvd
Ste 103
Torrance, CA 90503
Phone (310) 540-7240

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 10

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490227200000",
    "number": "1710088349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3661 TORRANCE BLVD",
            "address_2": "STE 103",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905034887",
            "telephone_number": "310-540-7240",
            "fax_number": "310-540-7280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21350 HAWTHORNE BLVD",
            "address_2": "SUITE 157",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905035605",
            "telephone_number": "310-540-7240",
            "fax_number": "310-540-7280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AIYEGBUSI",
        "first_name": "MODUPE",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2017-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A65390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Torrance, CA

Sources for this page

Verify at the official NPI Registry.