NPIMap

Organization Active NPI

Emergency Department Physicians Medical Group, Inc.

  • Emergency Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1730104498
Registry record updated Oct 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
EMERGENCY DEPARTMENT PHYSICIANS MEDICAL GROUP, INC.
Practice address
1225 Wilshire Boulevard
Los Angeles, CA 90017-2395
Phone
(213) 482-2741
NPI assigned
Jul 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2008

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

Authorized official

Name
Dr. Philip J Fagan, M.D.
Title
President
Phone
(818) 557-0135

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

1225 Wilshire Boulevard
Los Angeles, CA 90017-2395

Mailing address

2550 North Hollywood Way
Suite 209
Burbank, CA 91505-5015
Phone (818) 557-0135

Other identifiers 3

IdentifierTypeStateIssuer
GR0014357MedicaidCA
CC6638OtherCAGOOD SAM RAILROAD
ZZZ42800ZOtherCAGOOD SAM BLUE SHIELD

National Provider Directory

National Provider Directory

Locations

2550 N Hollywood Way
Ste 209
Burbank, CA 91505

Practitioners & affiliated clinicians

Practitioners 37

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 37

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223596800000",
    "number": "1730104498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 NORTH HOLLYWOOD WAY",
            "address_2": "SUITE 209",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915055015",
            "telephone_number": "818-557-0135",
            "fax_number": "818-557-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 WILSHIRE BOULEVARD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900172395",
            "telephone_number": "213-482-2741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY DEPARTMENT PHYSICIANS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2008-10-10",
        "status": "A",
        "authorized_official_last_name": "FAGAN",
        "authorized_official_first_name": "PHILIP",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-557-0135",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0014357",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GOOD SAM RAILROAD",
            "identifier": "CC6638",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GOOD SAM BLUE SHIELD",
            "identifier": "ZZZ42800Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; 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.