Active NPI
Horus Multispeciality Medical Group
- Interventional Pain Medicine Physician
- Lakewood, CA
National Provider Identifier
1831812692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Interventional Pain Medicine Physician
- Legal business name
- HORUS MULTISPECIALITY MEDICAL GROUP
- Practice address
- 5220 Clark Ave Ste 200
Lakewood, CA 90712-2641 - Phone
- (562) 210-5141
- Fax
- (562) 210-5127
- NPI assigned
- Sep 26, 2022
- 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
- Danielle Lutje
- Title
- Office Administrator
- Phone
- (562) 210-5141
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Interventional Pain Medicine Physician | 208VP0014X | Primary |
Addresses
Primary practice location
5220 Clark Ave Ste 200
Lakewood, CA 90712-2641
Mailing address
5220 Clark Ave Ste 200
Lakewood, CA 90712-2641
Phone (562) 210-5141
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250501002901 | CA | Part B Supplier - Clinic/Group Practice | 9739605734 |
Receives reassigned benefits from 5 practitioners Practice locations: Lakewood, CA |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physician Assistant
- Santa Ana, CA
- NPI 1902092596
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1737504000000",
"number": "1831812692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5220 CLARK AVE STE 200",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907122641",
"telephone_number": "562-210-5141",
"fax_number": "562-210-5127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5220 CLARK AVE STE 200",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907122641",
"telephone_number": "562-210-5141",
"fax_number": "562-210-5127"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HORUS MULTISPECIALITY MEDICAL GROUP",
"organizational_subpart": "NO",
"enumeration_date": "2022-09-26",
"last_updated": "2025-01-22",
"certification_date": "2025-01-22",
"status": "A",
"authorized_official_last_name": "LUTJE",
"authorized_official_first_name": "DANIELLE",
"authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
"authorized_official_telephone_number": "562-210-5141"
},
"taxonomies": [
{
"code": "208VP0014X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pain Medicine, Interventional Pain Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.