Active NPI
Providence Medical Institute
- Family Medicine Physician
- Torrance, CA
National Provider Identifier
1760425862
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- PROVIDENCE MEDICAL INSTITUTE
- Practice address
- 4101 Torrance Blvd
Torrance, CA 90503-4607 - Phone
- (310) 793-8075
- Fax
- (310) 793-8195
- NPI assigned
- Jun 14, 2006
- 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
- Donald Wayne Anderson Jr.
- Title
- Assistant Secretary of Enrollments
- Phone
- (425) 358-9786
Specialties & licenses 10
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | |||
| Emergency Medicine Physician | 207P00000X | |||
| Family Medicine Physician | 207Q00000X | Primary | ||
| Internal Medicine Physician | 207R00000X | |||
| Rheumatology Physician | 207RR0500X | |||
| Obstetrics & Gynecology Physician | 207V00000X | |||
| Orthopaedic Surgery Physician | 207X00000X | |||
| Pediatrics Physician | 208000000X | |||
| Hospitalist Physician | 208M00000X | |||
| Urgent Care Clinic/Center | 261QU0200X |
Addresses
Primary practice location
4101 Torrance Blvd
Torrance, CA 90503-4607
Mailing address
PO Box 31001-3029
Pasadena, CA 91110-3029
Phone (310) 792-4015
Other names 1
- Providence Little Company of Mary Medical Institute
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA, WA, OR, AK, IL, CO, FL, MI, MT, NC, NV, TN, HI, TX, NY, GA, DC, ID, AZ, WI, NE, UT, PA
Enrollment records 23
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Other NPIs on the same Medicare enrollment 5
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Family Medicine Physician
- Torrance, CA
- NPI 1235182569
O20031121000910, O20200507001918
National Provider Directory
National Provider DirectoryLocations
3475 Torrance Blvd
Ste A
Torrance, CA 90503
Phone (310) 370-3568
4201 Torrance Blvd
Ste 260
Torrance, CA 90503
Phone (424) 212-5333
550 17th Ave
Fl 4W
Seattle, WA 98122
Practitioners & affiliated clinicians
Practitioners 295
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1747008000000",
"number": "1760425862",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31001-3029",
"city": "PASADENA",
"state": "CA",
"postal_code": "911103029",
"telephone_number": "310-792-4015",
"fax_number": "310-792-4093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 TORRANCE BLVD",
"city": "TORRANCE",
"state": "CA",
"postal_code": "905034607",
"telephone_number": "310-793-8075",
"fax_number": "310-793-8195"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PROVIDENCE MEDICAL INSTITUTE",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-14",
"last_updated": "2025-05-12",
"certification_date": "2025-05-12",
"status": "A",
"authorized_official_last_name": "ANDERSON",
"authorized_official_first_name": "DONALD",
"authorized_official_middle_name": "WAYNE",
"authorized_official_title_or_position": "ASSISTANT SECRETARY OF ENROLLMENTS",
"authorized_official_telephone_number": "425-358-9786",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RR0500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Rheumatology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207V00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Obstetrics & Gynecology",
"state": null,
"license": null,
"primary": false
},
{
"code": "207X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Orthopaedic Surgery",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": null,
"license": null,
"primary": false
},
{
"code": "208M00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Hospitalist",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Providence Little Company of Mary Medical Institute",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Providence Little Company of Mary Medical Institute",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Torrance, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; 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.