Individual provider Active NPI

Debra R Judelson, M.D.

  • Cardiovascular Disease Physician
  • Beverly Hills, CA
National Provider Identifier
1790757136
Registry record updated Dec 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
G35161 Issued in CA
Practice address
414 N Camden Dr
Ste 1100
Beverly Hills, CA 90210-4532
Phone
(310) 278-3400
Fax
(310) 278-1240
NPI assigned
Feb 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X G35161 CA Primary

Addresses

Primary practice location

414 N Camden Dr
Ste 1100
Beverly Hills, CA 90210-4532

Mailing address

414 N Camden Dr
Ste 1100
Beverly Hills, CA 90210-4532
Phone (310) 278-3400

Other identifiers 1

IdentifierTypeStateIssuer
00G351610MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G35161CAMDCardiovascular Disease Physician

Interoperability endpoints

  • Direct secure messaging: djudelson102997@direct.cshs.org

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260748800000",
    "number": "1790757136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 N CAMDEN DR",
            "address_2": "STE 1100",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902104532",
            "telephone_number": "310-278-3400",
            "fax_number": "310-278-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 N CAMDEN DR",
            "address_2": "STE 1100",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902104532",
            "telephone_number": "310-278-3400",
            "fax_number": "310-278-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUDELSON",
        "first_name": "DEBRA",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-01",
        "last_updated": "2009-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "G35161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G351610",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.