NPIMap

Organization Active NPI

Victorian Care Medical Group, Inc.

  • Internal Medicine Physician
  • Inglewood, CA
National Provider Identifier
1821172008
Registry record updated Nov 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
W9384 Issued in CA
Legal business name
VICTORIAN CARE MEDICAL GROUP, INC.
Practice address
11149 Crenshaw Blvd
Inglewood, CA 90303-2338
Phone
(310) 677-4600
Fax
(310) 677-4600
NPI assigned
Oct 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2017

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

Authorized official

Name
Nwachukwu A. Anakwenze, MDNPI 1255417309
Title
Owner/Doctor
Phone
(310) 677-4600

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X W9384 CA Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

11149 Crenshaw Blvd
Inglewood, CA 90303-2338

Mailing address

PO Box 88939
Los Angeles, CA 90009-6939
Phone (310) 677-4600

Other identifiers 1

IdentifierTypeStateIssuer
00G506070MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031112000672 CA Part B Supplier - Clinic/Group Practice 7911810197 Receives reassigned benefits from 2 practitioners
Practice locations: Inglewood, CA; Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

11149 Crenshaw Blvd
Inglewood, CA 90303
Phone (310) 677-4600

600 W Manchester Ave
Ste 3
Los Angeles, CA 90044
Phone (323) 758-3077

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 & 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": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1821172008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88939",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900096939",
            "telephone_number": "310-677-4600",
            "fax_number": "310-914-9705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11149 CRENSHAW BLVD",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903032338",
            "telephone_number": "310-677-4600",
            "fax_number": "310-677-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORIAN CARE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "ANAKWENZE",
        "authorized_official_first_name": "NWACHUKWU",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER/DOCTOR",
        "authorized_official_telephone_number": "310-677-4600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "W9384",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G506070",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; 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.