Individual provider Active NPI

Benjamin Aaron Waterman

  • Internal Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1740623008
Registry record updated Feb 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A136262 Issued in CA
Practice address
757 Westwood PLZ
Suite 7501
Los Angeles, CA 90095-7417
Phone
(310) 825-7375
NPI assigned
Apr 16, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A136262 CA Primary

Addresses

Primary practice location

757 Westwood PLZ
Suite 7501
Los Angeles, CA 90095-7417

Mailing address

757 Westwood PLZ
Suite 7501
Los Angeles, CA 90095-7417
Phone (310) 825-7375

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
I20160713000587 CA Practitioner - Internal Medicine 4385936210 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
A136262CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Jan 1, 2021 Accepting new patients
County of Los Angeles Auditor Controller CurrentSince Jan 1, 2021 Accepting new patients
County of Los Angeles Current Accepting new patients

Locations

14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303

14445 Olive View Dr
#R
Sylmar, CA 91342
Phone (949) 433-7198

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1366070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582588800000",
    "number": "1740623008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "757 WESTWOOD PLZ",
            "address_2": "SUITE 7501",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900957417",
            "telephone_number": "310-825-7375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 WESTWOOD PLZ",
            "address_2": "SUITE 7501",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900957417",
            "telephone_number": "310-825-7375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "BENJAMIN",
        "middle_name": "AARON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-16",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A136262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.