La Community Care Medical

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A053317 Issued in CA

Legal business name

LA COMMUNITY CARE MEDICAL

Practice address

11633 Hawthorne Blvd Ste 103
Hawthorne, CA 90250-2323

Phone

(310) 219-2929

Fax

(310) 219-2940

NPI assigned

Jun 8, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Augustine Iluore, MDNPI 1336205442

Title

Medical Director

Phone

(310) 219-2929

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• LA COMMUNITY CARE MEDICAL ASSOCIATES INC Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 3

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

• Augustine Iluore, MD

  • Internal Medicine Physician
  • Hawthorne, CA
  • NPI 1336205442
  Medicare reassignment Authorized official
• Jessica Smith, D.C.

  • Chiropractor
  • Hawthorne, CA
  • NPI 1629122981
  NPD (past)
• Kristen Wong

  • Family Nurse Practitioner
  • Hawthorne, CA
  • NPI 1477094787
  NPD (past)

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

{
    "created_epoch": "1181260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492128000000",
    "number": "1801099486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11633 HAWTHORNE BLVD STE 103",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11633 HAWTHORNE BLVD STE 103",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502323",
            "telephone_number": "310-219-2929",
            "fax_number": "310-219-2940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA COMMUNITY CARE MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-08",
        "last_updated": "2017-04-14",
        "status": "A",
        "authorized_official_last_name": "ILUORE",
        "authorized_official_first_name": "AUGUSTINE",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "310-219-2929",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A053317",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A053317",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0081270",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LA COMMUNITY CARE MEDICAL ASSOCIATES INC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Pooja Kumar, M.D.
• Dannylyn Joy Kwak
• Kevin Robinson Kwan, MSN
• Kwang Jin Kim DDS
• James Kwok, D.O.
• La Dental Care
• La Ride LLC
• La Vida Multi-Specialty Medical Group
• La Vida Multispecialty Medical Group Inc
• Jamie Marie Lacroix, SLPA

• Family Medicine Physician in Hawthorne, CA
• Providers in Hawthorne, 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 Apr 14, 2017; 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.