Active NPI
Cep America - California
- Emergency Medicine Physician
- Banning, CA
National Provider Identifier
1750336269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- Legal business name
- CEP AMERICA - CALIFORNIA
- Practice address
- 600 N. Highland Springs Avenue
Banning, CA 92220-3090 - Phone
- (951) 845-1121
- NPI assigned
- May 23, 2006
- Last updated
- May 11, 2016
- 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. Theophile Koury, MD
- Title
- Coo
- Phone
- (510) 350-2600
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | Primary |
Addresses
Primary practice location
600 N. Highland Springs Avenue
Banning, CA 92220-3090
Mailing address
2100 Powell Street
Ste. 920
Emeryville, CA 94608-1803
Phone (510) 350-2777
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0013023 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000520 | CA | Part B Supplier - Clinic/Group Practice | 6103739131 |
Receives reassigned benefits from 3,525 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 3
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.
-
- Emergency Medicine Physician
- Walnut Creek, CA
- NPI 1568483691
-
- Emergency Medicine Physician
- Simi Valley, CA
- NPI 1518293943
Single Specialty
-
- Emergency Medicine Physician
- Wildomar, CA
- NPI 1104976661
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148342400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1462924800000",
"number": "1750336269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 POWELL STREET",
"address_2": "STE. 920",
"city": "EMERYVILLE",
"state": "CA",
"postal_code": "946081803",
"telephone_number": "510-350-2777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "600 N. HIGHLAND SPRINGS AVENUE",
"city": "BANNING",
"state": "CA",
"postal_code": "922203090",
"telephone_number": "951-845-1121"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CEP AMERICA - CALIFORNIA",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-23",
"last_updated": "2016-05-11",
"status": "A",
"authorized_official_last_name": "KOURY",
"authorized_official_first_name": "THEOPHILE",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "510-350-2600",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "GR0013023",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Banning, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2016; 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.