NPIMap

Organization Active NPI

Private Medical Group

  • Internal Medicine Physician
  • Woodland Hills, CA
National Provider Identifier
1710104369
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G62711 Issued in CA
Legal business name
PRIVATE MEDICAL GROUP
Practice address
22600 Ventura Blvd.
Suite 104
Woodland Hills, CA 91364-1458
Phone
(818) 225-1617
Fax
(818) 225-1620
NPI assigned
Apr 18, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert Kevin Hanson, M.D.NPI 1447213616
Title
Owner
Phone
(818) 225-1617

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
Internal Medicine Physician 207R00000X G62711 CA Primary

Addresses

Primary practice location

22600 Ventura Blvd.
Suite 104
Woodland Hills, CA 91364-1458

Mailing address

22600 Ventura Blvd.
Suite 104
Woodland Hills, CA 91364-1458
Phone (818) 225-1617

Other identifiers 2

IdentifierTypeStateIssuer
G62711OtherCASTATE LICENSE
ZZZ90227ZOtherOLD GROUP IDENTIFIER #

Other names 1

  • Robert K. Hanson M.D. Former legal business name

National Provider Directory

National Provider Directory

Locations

22600 Ventura Blvd
Ste 104
Woodland Hls, CA 91364
Phone (818) 225-1617

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 1

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": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1710104369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22600 VENTURA BLVD.",
            "address_2": "SUITE 104",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913641458",
            "telephone_number": "818-225-1617",
            "fax_number": "818-225-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22600 VENTURA BLVD.",
            "address_2": "SUITE 104",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913641458",
            "telephone_number": "818-225-1617",
            "fax_number": "818-225-1620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIVATE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-225-1617",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G62711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "G62711",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OLD GROUP IDENTIFIER #",
            "identifier": "ZZZ90227Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Robert K. Hanson M.D.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Woodland Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.