NPIMap

Organization Active NPI

Southland Renal Medical Group, Inc.

  • Nephrology Physician
  • Long Beach, CA
National Provider Identifier
1730110495
Registry record updated Jul 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A46344 Issued in CA
Legal business name
SOUTHLAND RENAL MEDICAL GROUP, INC.
Practice address
3300 E. South Street
Suite 308
Long Beach, CA 90805-4598
Phone
(562) 630-3111
Fax
(562) 630-3107
NPI assigned
Jul 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2024

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

Authorized official

Name
Dr. Avedik Semerjian, MD, FACP, FASNNPI 1831120591
Title
President
Phone
(562) 630-3111

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
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X A46344 CA Primary

Addresses

Primary practice location

3300 E. South Street
Suite 308
Long Beach, CA 90805-4598

Mailing address

PO Box 879
Lakewood, CA 90714-0879
Phone (562) 630-3111

Other identifiers 1

IdentifierTypeStateIssuer
GR0093370MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050718001019 CA Part B Supplier - Clinic/Group Practice 3476580838 Receives reassigned benefits from 9 practitioners
5 other NPIs on this enrollment
Practice locations: Downey, CA; Lakewood, CA; Los Alamitos, CA

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Locations

3300 E South St
Ste 207
Lakewood, CA 90805
Phone (562) 602-5503

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1730110495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 879",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907140879",
            "telephone_number": "562-630-3111",
            "fax_number": "562-630-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 E. SOUTH STREET",
            "address_2": "SUITE 308",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908054598",
            "telephone_number": "562-630-3111",
            "fax_number": "562-630-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND RENAL MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "SEMERJIAN",
        "authorized_official_first_name": "AVEDIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-630-3111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, FACP, FASN"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A46344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0093370",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.