Individual provider Active NPI

Justin Michael Greenberg, D.O.

  • Pediatric Critical Care Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1710383187
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
20A14267 Issued in CA
Practice address
200 UCLA Medical PLZ Ste 265
Los Angeles, CA 90095-8344
Phone
(310) 825-0867
Fax
(310) 794-5066
NPI assigned
Nov 13, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 20A14267 CA
Pediatric Critical Care Medicine Physician 2080P0203X DO2907 NV
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Critical Care Medicine Physician 2080P0203X 20A14267 CA Primary

Addresses

Primary practice location

200 UCLA Medical PLZ Ste 265
Los Angeles, CA 90095-8344

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other practice location 1

University Medical Center of Southern Nevada
1800 W. Charleston Blvd.
Las Vegas, NV 89102
Phone (702) 383-2420

Other practice location 2

1600 W Avenue J
Lancaster, CA 93534-2814
Phone (661) 949-5000

Other practice location 3

2020 Zonal Ave
IRD Suite 112
Los Angeles, CA 90033
Phone (323) 226-5584

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200710002687 CA Practitioner - Critical Care (Intensivists)Practitioner - Pediatric Medicine 6507289428 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A14267CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents Pediatrics CurrentSince Jan 1, 2023 Accepting new patients
UCLA Medical Group Pediatrics Past Accepting new patients

Locations

1600 W Avenue J
Lancaster, CA 93534
Phone (661) 726-6254

200 UCLA Medical Plz
Ste 265
Los Angeles, CA 90095
Phone (310) 206-2429

File 2939
Los Angeles, CA 90074
Phone (310) 794-6596

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

10833 Le Conte Ave
#12311
Los Angeles, CA 90095
Phone (310) 825-9124

1260 15th St
Ste 1024
Santa Monica, CA 90404
Phone (424) 259-8570

215 W Janss Rd
Thousand Oaks, CA 91360
Phone (805) 379-5435

Interoperability endpoints

  • Direct secure messaging: jgreenberg1122623@direct.uclahealth.org

Organizations & group practices 2

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": "1415836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1710383187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ STE 265",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900958344",
            "telephone_number": "310-825-0867",
            "fax_number": "310-794-5066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "University Medical Center of Southern Nevada",
            "address_2": "1800 W. Charleston Blvd.",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "89102",
            "country_code": "US",
            "telephone_number": "702-383-2420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1600 W Avenue J",
            "address_purpose": "LOCATION",
            "city": "Lancaster",
            "state": "CA",
            "postal_code": "935342814",
            "country_code": "US",
            "telephone_number": "661-949-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2020 Zonal Ave",
            "address_2": "IRD Suite 112",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90033",
            "country_code": "US",
            "telephone_number": "323-226-5584",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENBERG",
        "first_name": "JUSTIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-11-13",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A14267",
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "NV",
            "license": "DO2907",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "CA",
            "license": "20A14267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.