Active NPI
California Emergency Physc Med GRP
- Urgent Care Clinic/Center
- Eureka, CA
National Provider Identifier
1831406578
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urgent Care Clinic/Center
- Legal business name
- CALIFORNIA EMERGENCY PHYSC MED GRP
- Practice address
- 2700 Dolbeer St
Eureka, CA 95501-4736 - Phone
- (707) 269-3610
- NPI assigned
- Sep 1, 2010
- Last updated
- Aug 16, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Theophile Koury, MD
- Title
- Coo
- Phone
- (510) 350-2600
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urgent Care Clinic/Center | 261QU0200X | Primary |
Addresses
Primary practice location
2700 Dolbeer St
Eureka, CA 95501-4736
Mailing address
2100 Powell St
Suite 900
Emeryville, CA 94608-1826
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031106000520 | CA | Part B Supplier - Clinic/Group Practice | 6103739131 |
Receives reassigned benefits from 3,525 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
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.
-
- Emergency Medicine Physician
- Walnut Creek, CA
- NPI 1568483691
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283299200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1376611200000",
"number": "1831406578",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2100 POWELL ST",
"address_2": "SUITE 900",
"city": "EMERYVILLE",
"state": "CA",
"postal_code": "946081826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2700 DOLBEER ST",
"city": "EUREKA",
"state": "CA",
"postal_code": "955014736",
"telephone_number": "707-269-3610"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CALIFORNIA EMERGENCY PHYSC MED GRP",
"organizational_subpart": "NO",
"enumeration_date": "2010-09-01",
"last_updated": "2013-08-16",
"status": "A",
"authorized_official_last_name": "KOURY",
"authorized_official_first_name": "THEOPHILE",
"authorized_official_title_or_position": "COO",
"authorized_official_telephone_number": "510-350-2600",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Eureka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.