Prohealth Partners, a Medical Group, Inc.
Organization Active NPI Internal Medicine Physician · Long Beach, CA
NPI 1780717652 · NPPES record last updated Apr 17, 2023
Key facts
- NPI
- 1780717652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- PROHEALTH PARTNERS, A MEDICAL GROUP, INC.
- Practice address
- 1045 Atlantic Ave Ste 505
Long Beach, CA 90813 - Phone
- (562) 495-4952
- Fax
- (562) 495-3795
- NPI assigned
- Mar 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Barry Steven Allswang, MD
- Title
- President
- Phone
- (562) 299-5200
Corporate family (same tax ID) 24
Practitioners 3
-
Ruby Elaine Calalo, AGACNP-BC
-
Kara Lauren De Winter, M.D.
-
Jennifer Ngo, FNP-BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031211000927 | CA | Part B Supplier - Clinic/Group Practice | 2769388412 |
Receives reassigned benefits from 296 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Prohealth Partners a M
Locations
2801 Atlantic Ave
Long Beach, CA 90806
Phone (310) 933-2000
1040 Elm Ave
Ste 302
Long Beach, CA 90813
Phone (562) 495-4952
1045 Atlantic Ave
Ste 505
Long Beach, CA 90813
Phone (562) 437-0996
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician |
207R00000X | Yes |
Addresses
Primary practice location
1045 Atlantic Ave Ste 505
Long Beach, CA 90813
Mailing address
1045 Atlantic Ave Ste 505
Long Beach, CA 90813-3422
Phone (562) 495-4952
Other practice location 1
1040 Elm Ave Ste 302
Long Beach, CA 90813-3267
Phone (562) 495-4952
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0064154 | Medicaid | CA | |
| ZZZ47090Z | Other | CA | BLUE SHIELD GROUP NUMBER |
Other providers in Long Beach, CA
- Prohealth Partners, a Medical Group, Inc.
- Prohealth Partners, a Medical Group, Inc.
- Prohealth Partners, a Medical Group, Inc.
- Prohealth Partners, a Medical Group, Inc.
- Prohealth Partners, a Medical Group, Inc.
- Prohealth Partners, a Medical Group, Inc.
- Prohealth Partners, a Medical Group, Inc.
- Project Return Peer Support Network
- Project Return Peer Support Network
- Kristina Prokopiak
All providers in Long Beach, CA · Internal Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2023. 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.