Hollywood Internal Medicine Clinic Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

HOLLYWOOD INTERNAL MEDICINE CLINIC INC

Practice address

5101 Hollywood Blvd
Los Angeles, CA 90027-6105

Phone

(323) 426-9139

Fax

(323) 426-9140

NPI assigned

Feb 19, 2024

Organization subpart

No

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

Authorized official

Name

Jeffrey Crudo, MDNPI 1508987371

Title

Ceo/President

Phone

(323) 426-9139

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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.

• Jeffrey John Crudo, M.D.

  • Internal Medicine Physician
  • Laguna Beach, CA
  • NPI 1508987371
  Medicare reassignment NPD Authorized official
• Dominique Eboniece Martinez, FNP-BC

  • Family Nurse Practitioner
  • Glendale, NY
  • NPI 1225713829

  CA

  Medicare reassignment NPD
• Babic Gary Babikian, RPH

  • Pharmacist
  • Los Angeles, CA
  • NPI 1235347543
  NPD (past)

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

{
    "created_epoch": "1708300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1780449744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5101 HOLLYWOOD BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276105",
            "telephone_number": "323-426-9139",
            "fax_number": "323-426-9140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5101 HOLLYWOOD BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276105",
            "telephone_number": "323-426-9139",
            "fax_number": "323-426-9140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLYWOOD INTERNAL MEDICINE CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-19",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "CRUDO",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "323-426-9139",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hollywood Heart and Vascular Group, a Medical Corporation
• Hollywood Home Health Care, Inc
• Hollywood Home Health Services Inc
• Hollywood Hospitalist Medical Group, Inc.
• Hollywood Imaging&Diagnostic.Inc
• Hollywood Lifestyle Dermaotogy
• Hollywood Luxury Rehab
• Hollywood Medical Center
• Hollywood Medical Primary Care Inc
• Hollywood Medical Rehabilitaion Care, Inc

• Family Medicine Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2024; 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.