Southern California Permanente Medical Group
Organization Active NPI Health Maintenance Organization · Baldwin Park, CA
NPI 1770515280 · NPPES record last updated Oct 1, 2021
Key facts
- NPI
- 1770515280
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Maintenance Organization 302R00000X
- Legal business name
- SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
- Practice address
- 1011 Baldwin Park Blvd
Baldwin Park, CA 91706-5806 - Phone
- (626) 851-1011
- NPI assigned
- Jul 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Ramin Davidoff, M.D.
- Title
- Executive Medical Director
- Phone
- (877) 608-0044
Other NPIs on the same Medicare enrollment 24
Other NPIs with the same Medicare PAC ID 3
Practitioners 17,180
-
Arad Abadi, MD
-
Mekabiz Abaian, MD
-
Kelechi Abanobi, M.D
-
Iman Abdalla, MD
-
Nisrin Abdelsamie, FNP
-
Behnam Abdollahi, MD
-
Sarah Abdulla, M.D.
-
Terri Leigh Abe, MD
-
Jennifer Rebecca Abell-Davis, BS, DPT, MT
-
Reina Abeyta, MSN, FNP-BC
-
Muhammad Omar Abou-Harb, HEALTH CARE 39020000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031110000678 | CA | Part B Supplier - Clinic/Group Practice | 6002729175 |
Receives reassigned benefits from 14,591 practitioners 21 other NPIs on this enrollment |
| O20260217001864 | CA | MDPP Supplier - in-Person MDPP Supplier With Distance Learning | 6002729175 |
12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Locations
5 Centerpointe Dr
La Palma, CA 90623
Phone (714) 562-3350
6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000
8001 Ventura Canyon Ave
Panorama City, CA 91402
Phone (818) 375-2028
30400 Camino Capistrano
San Juan Capistrano, CA 92675
Phone (866) 353-5054
26415 Carl Boyer Dr
Santa Clarita, CA 91350
Phone (661) 287-4048
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Maintenance Organization | 302R00000X | Yes |
Addresses
Primary practice location
1011 Baldwin Park Blvd
Baldwin Park, CA 91706-5806
Mailing address
393 E Walnut St
3Rd FL PHR Group & Provider Enrollment
Pasadena, CA 91188-0001
Phone (626) 405-7914
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0018333 | Medicaid | CA |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq | Health Information Exchange (HIE) | Southern California Permanente Medical Group |
Other providers in Baldwin Park, CA
- Cherry Canlas Soriano
- Sylvia Maria Soriano
- Sorour D.M.D Corporation
- Vincenza D. Sorrells
- Josephine Rae Sotto
- Mark T. Speakman
- Howard M. Speil
- Joey Spitzer
- William Spradlin
- St Medical Institute
All providers in Baldwin Park, CA · Health Maintenance Organization in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.