Active NPI
Los Alamitos Internal Medical Group Inc
- Specialist
- Los Alamitos, CA
National Provider Identifier
1720035686
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- A73497
- Legal business name
- LOS ALAMITOS INTERNAL MEDICAL GROUP INC
- Practice address
- 5300 Katella Ave
Los Alamitos, CA 90720-2808 - Phone
- (562) 430-7533
- Fax
- (562) 430-8055
- NPI assigned
- May 27, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Steven T. Forman, M.D.
- Title
- President
- Phone
- (562) 430-7533
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | A73497 | CA | Primary |
Addresses
Primary practice location
5300 Katella Ave
Los Alamitos, CA 90720-2808
Mailing address
5300 Katella Ave
Los Alamitos, CA 90720-2808
Phone (562) 430-7533
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G338210 | Medicaid | CA | |
| 00A452500 | Medicaid | CA | |
| 00G472290 | Medicaid | CA | |
| 00G853440 | Medicaid | CA | |
| 00G658950 | Medicaid | CA |
Other names 1
- LOS ALAMITOS CARDIOVASCULAR
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050126001139 | CA | Part B Supplier - Clinic/Group Practice | 6507816642 |
Receives reassigned benefits from 9 practitioners Practice locations: Los Alamitos, CA |
National Provider Directory
National Provider DirectoryLocations
5832 Beach Blvd
Unit 214
Buena Park, CA 90621
Phone (714) 486-2586
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Practitioners & affiliated clinicians
Practitioners 9
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1663891200000",
"number": "1720035686",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5300 KATELLA AVE",
"city": "LOS ALAMITOS",
"state": "CA",
"postal_code": "907202808",
"telephone_number": "562-430-7533",
"fax_number": "562-430-8055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5300 KATELLA AVE",
"city": "LOS ALAMITOS",
"state": "CA",
"postal_code": "907202808",
"telephone_number": "562-430-7533",
"fax_number": "562-430-8055"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "LOS ALAMITOS INTERNAL MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-27",
"last_updated": "2022-09-23",
"certification_date": "2022-09-23",
"status": "A",
"authorized_official_last_name": "FORMAN",
"authorized_official_first_name": "STEVEN",
"authorized_official_middle_name": "T.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "562-430-7533",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D."
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "CA",
"license": "A73497",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G338210",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A452500",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G472290",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G853440",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G658950",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "LOS ALAMITOS CARDIOVASCULAR",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Los Alamitos, CA
- Los Alamitos Endodontics Dental Practice of Polk and Livingford
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- Los Alamitos OB-GYN Medical Group
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.