Brentwood Orthopedic and Spine Surgery LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

A100370 Issued in CA

Legal business name

BRENTWOOD ORTHOPEDIC AND SPINE SURGERY LLC

Practice address

11980 San Vicente Blvd
Suite 110
Los Angeles, CA 90049-5012

Phone

(310) 337-7463

Fax

(310) 442-8336

NPI assigned

Aug 28, 2014

Last updated

Nov 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Moshe H. Wilker, M.D.NPI 1639214257

Title

President

Phone

(310) 337-7463

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821498635. Details of each certification follow.

• CCN 55C0001227 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 55C0001227

Legal name

Brentwood Orthopedic and Spine Surgery, LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Jun 8, 2025

Last certification

May 29, 2025

Facility address

11980 San Vicente Blvd.
Los Angeles, CA 90049

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/9708/brand/1/csg/1/fhir/r4

Practitioners 1

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.

• Moshe Wilker, M.D.

  • Orthopaedic Surgery of the Spine Physician
  • Los Angeles, CA
  • NPI 1639214257
  NPD Authorized official

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

{
    "created_epoch": "1409184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1821498635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11980 SAN VICENTE BLVD",
            "address_2": "SUITE 110",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495012",
            "telephone_number": "310-337-7463",
            "fax_number": "310-442-8336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11980 SAN VICENTE BLVD",
            "address_2": "SUITE 110",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495012",
            "telephone_number": "310-337-7463",
            "fax_number": "310-442-8336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENTWOOD ORTHOPEDIC AND SPINE SURGERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-28",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "WILKER",
        "authorized_official_first_name": "MOSHE",
        "authorized_official_middle_name": "H.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-337-7463",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "A100370",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.