NPIMap

Organization Active NPI

Axiom Anesthesia a Professional Nursing Corporation

  • Anesthesiology Physician
  • Beverly Hills, CA
National Provider Identifier
1760150155
Registry record updated Sep 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
AXIOM ANESTHESIA A PROFESSIONAL NURSING CORPORATION
Practice address
TLC Surgical Center 240 S la Cienega Blvd
Suite 210
Beverly Hills, CA 90211-3324
Phone
(310) 882-5454
NPI assigned
Sep 1, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2021

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

Authorized official

Name
Dr. Elizabeth Bamgbose, CRNANPI 1326133109
Title
Ceo
Phone
(585) 732-4214

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
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

TLC Surgical Center 240 S la Cienega Blvd
Suite 210
Beverly Hills, CA 90211-3324

Mailing address

1158 26TH St Ste 131
Santa Monica, CA 90403-4621
Phone (323) 289-2389

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://app.followthatpatient.com/home.php Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211025002427 CA Part B Supplier - Clinic/Group Practice 5395133326 Receives reassigned benefits from 34 practitioners
Practice locations: Beverly Hills, CA; Santa Monica, CA; Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

240 S La Cienega Blvd
Ste 210
Beverly Hills, CA 90211
Phone (310) 882-5454

2632 Wilshire Blvd
Ste 131
Santa Monica, CA 90403

1158 26th St
Ste 131
Santa Monica, CA 90403

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": "1630454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630454400000",
    "number": "1760150155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1158 26TH ST STE 131",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034621",
            "telephone_number": "323-289-2389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "TLC SURGICAL CENTER 240 S LA CIENEGA BLVD",
            "address_2": "SUITE 210",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902113324",
            "telephone_number": "310-882-5454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIOM ANESTHESIA A PROFESSIONAL NURSING CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-01",
        "last_updated": "2021-09-01",
        "certification_date": "2021-08-16",
        "status": "A",
        "authorized_official_last_name": "BAMGBOSE",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "585-732-4214",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://app.followthatpatient.com/home.php",
            "affiliation": "N",
            "endpointDescription": "electronic medical record",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "patient care content: labs, clinic notes, anesthesia records, etc.",
            "address_1": "TLC Surgical Center 240 S La Cienega Blvd",
            "address_2": "Suite 210",
            "city": "Beverly Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902113324",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; 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.