NPIMap

Organization Active NPI

University of Southern California

Doing business as USC School of Dentistry

  • General Practice Dentistry
  • Los Angeles, CA
National Provider Identifier
1821168113
Registry record updated Mar 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
UNIVERSITY OF SOUTHERN CALIFORNIA
Doing business as
USC School of Dentistry
Practice address
925 W 34TH St
Room #151
Los Angeles, CA 90089-0641
Phone
(213) 740-7405
Fax
(213) 740-4813
NPI assigned
Nov 8, 2006
Last updated
Mar 8, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2010

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

Authorized official

Name
Mr. Todd Dickey
Title
Senior Vice President, Administrati
Phone
(213) 740-8184

Specialties & licenses 12

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223E0200X
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X Primary
Oral and Maxillofacial Pathology DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0106X
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X
ProsthodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0700X
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X
Oral and Maxillofacial Radiology DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0008X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X
Dental HygienistGroup: 193200000X MULTI-SPECIALTY GROUP 124Q00000X
Dental AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 126800000X
Dental Laboratory TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 126900000X

Addresses

Primary practice location

925 W 34TH St
Room #151
Los Angeles, CA 90089-0641

Mailing address

925 W 34TH St
Room #151
Los Angeles, CA 90089-0641
Phone (213) 740-7405

Other names 1

  • USC School of Dentistry Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040203001147 CA Part B Supplier - Clinic/Group Practice 5597658633 Receives reassigned benefits from 4 practitioners
Practice locations: Los Angeles, CA
O20140916000596 CA DME Supplier - Oral Surgery - Dentist 5597658633 Practice locations: Los Angeles, CA

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Usc Diagnostic CLNC32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Locations

1510 San Pablo St
Ste 144
Los Angeles, CA 90033
Phone (323) 442-5770

925 W 34th St
Rm 151
Los Angeles, CA 90089
Phone (213) 740-3410

925 W 34th St
Ste 151
Los Angeles, CA 90089
Phone (213) 740-1932

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Usc Kenneth Norris Jr Cancer HospitalLos Angeles, CA, CCN 050660 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 21, 2021
Usc Verdugo Hills HospitalGlendale, CA, CCN 050124 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 21, 2021
Usc Verdugo Hills HospitalGlendale, CA, CCN 05S124 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 21, 2021
Keck Hospital of UscLos Angeles, CA, CCN 050696 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2021

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 12

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": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268006400000",
    "number": "1821168113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 W 34TH ST",
            "address_2": "ROOM #151",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900890641",
            "telephone_number": "213-740-7405",
            "fax_number": "213-740-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 W 34TH ST",
            "address_2": "ROOM #151",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900890641",
            "telephone_number": "213-740-7405",
            "fax_number": "213-740-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF SOUTHERN CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2010-03-08",
        "status": "A",
        "authorized_official_last_name": "DICKEY",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT, ADMINISTRATI",
        "authorized_official_telephone_number": "213-740-8184",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0008X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Hygienist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "126800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "126900000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dental Laboratory Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "USC School of Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.