NPIMap

Organization Active NPI

County of Los Angeles

Doing business as Lake Los Angeles Community Clinic

  • Clinic/Center
  • Palmdale, CA
National Provider Identifier
1720090616
Registry record updated Dec 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
COUNTY OF LOS ANGELES
Doing business as
Lake Los Angeles Community Clinic
Practice address
16921 E Avenue O Ste G
Palmdale, CA 93591-3045
Phone
(661) 945-8444
NPI assigned
Aug 12, 2006
Last updated
Dec 26, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
COUNTY OF LOS ANGELESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 26, 2018

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

Authorized official

Name
Ms. Beryl Brooks
Title
Clinic Administrator
Phone
(323) 890-7775

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

16921 E Avenue O Ste G
Palmdale, CA 93591-3045

Mailing address

16921 E Avenue O Ste G
Palmdale, CA 93591-3045
Phone (661) 945-8444

Other names 1

  • Lake Los Angeles Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031204001218 CA Part B Supplier - Clinic/Group Practice 1850296534 Receives reassigned benefits from 1,953 practitioners
49 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Pacoima, CA; Monrovia, CA; North Hollywood, CA; Palmdale, CA; Pomona, CA; San Fernando, CA; Santa Monica, CA…

Other NPIs on the same Medicare enrollment 49

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 49

National Provider Directory

National Provider Directory
Tax ID family
Hudson Health Center613 organizations share this tax ID, including this one
Part of
Hudson Health Center

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

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": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545782400000",
    "number": "1720090616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16921 E AVENUE O STE G",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935913045",
            "telephone_number": "661-945-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16921 E AVENUE O STE G",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935913045",
            "telephone_number": "661-945-8444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF LOS ANGELES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COUNTY OF LOS ANGELES",
        "enumeration_date": "2006-08-12",
        "last_updated": "2018-12-26",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "BERYL",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "323-890-7775",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Los Angeles Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Los Angeles Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Palmdale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2018; 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.