Organization Active NPI

Internal Medicine MDS Corp

  • Internal Medicine Physician
  • Montebello, CA
National Provider Identifier
1811338270
Registry record updated Jul 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A102426 Issued in CA
Legal business name
INTERNAL MEDICINE MDS CORP
Practice address
3114 W Beverly Blvd
Montebello, CA 90640-2217
Phone
(323) 726-3868
Fax
(323) 726-3870
NPI assigned
Jul 15, 2013
Last updated
Jul 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2013

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

Authorized official

Name
Dr. Nazrul Islam, MDNPI 1629202841
Title
Physician
Phone
(323) 726-3868

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
Internal Medicine Physician 207R00000X A102426 CA Primary

Addresses

Primary practice location

3114 W Beverly Blvd
Montebello, CA 90640-2217

Mailing address

3114 W Beverly Blvd
Montebello, CA 90640-2217
Phone (323) 726-3868

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140103000208 CA Part B Supplier - Clinic/Group Practice 0042448722 Receives reassigned benefits from 2 practitioners
Practice locations: Montebello, CA

National Provider Directory

National Provider Directory

Locations

3114 W Beverly Blvd
Montebello, CA 90640
Phone (323) 726-1317

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1373846400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373846400000",
    "number": "1811338270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3114 W BEVERLY BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906402217",
            "telephone_number": "323-726-3868",
            "fax_number": "323-726-3870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3114 W BEVERLY BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906402217",
            "telephone_number": "323-726-3868",
            "fax_number": "323-726-3870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE MDS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-15",
        "last_updated": "2013-07-15",
        "status": "A",
        "authorized_official_last_name": "ISLAM",
        "authorized_official_first_name": "NAZRUL",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "323-726-3868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A102426",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montebello, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2013; 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.