NPIMap

Organization Active NPI

Herbert S Radley MD & Harold M Cohen MD Medical Corporation

  • Primary Care Clinic/Center
  • Sylmar, CA
National Provider Identifier
1790716447
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
HERBERT S RADLEY MD & HAROLD M COHEN MD MEDICAL CORPORATION
Practice address
14124 Foothill Blvd
Ste 100
Sylmar, CA 91342-8049
Phone
(818) 367-1012
Fax
(818) 367-7570
NPI assigned
Jul 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Basem Fanous, M.D.NPI 1619072600
Title
Cfo
Phone
(818) 367-1012

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
Primary Care Clinic/Center 261QP2300X CA Primary

Addresses

Primary practice location

14124 Foothill Blvd
Ste 100
Sylmar, CA 91342-8049

Mailing address

14124 Foothill Blvd
Ste 100
Sylmar, CA 91342-8049
Phone (818) 367-1012

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ70244ZMedicaidCA

Other names 1

  • Sylmar Medical Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040302001394 CA Part B Supplier - Clinic/Group Practice 5597652628 Receives reassigned benefits from 7 practitioners
Practice locations: Sylmar, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0558608Sylmar Medical Center14124 Foothill Blvd Ste 100, Sylmar, CA 91342Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1790716447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14124 FOOTHILL BLVD",
            "address_2": "STE 100",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913428049",
            "telephone_number": "818-367-1012",
            "fax_number": "818-367-7570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14124 FOOTHILL BLVD",
            "address_2": "STE 100",
            "city": "SYLMAR",
            "state": "CA",
            "postal_code": "913428049",
            "telephone_number": "818-367-1012",
            "fax_number": "818-367-7570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERBERT S RADLEY MD & HAROLD M COHEN MD MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2022-07-21",
        "certification_date": "2020-02-18",
        "status": "A",
        "authorized_official_last_name": "FANOUS",
        "authorized_official_first_name": "BASEM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "818-367-1012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ70244Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sylmar Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sylmar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.