Eastside Diabetes Care Medical Clinic, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

A33652 Issued in CA

Legal business name

EASTSIDE DIABETES CARE MEDICAL CLINIC, INC.

Practice address

5836 E Beverly Blvd
Los Angeles, CA 90022-2824

Phone

(323) 726-0370

Fax

(323) 726-0239

NPI assigned

Oct 19, 2010

Organization subpart

No

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

Authorized official

Name

Mrs. Altagracia A Rodriguez

Title

Office Manager

Phone

(323) 726-0370

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Miguel E Rodriguez, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Los Angeles, CA
  • NPI 1972600880
  Medicare reassignment

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

{
    "created_epoch": "1287446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424995200000",
    "number": "1841500253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5836 E BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900222824",
            "telephone_number": "323-726-0370",
            "fax_number": "323-726-0239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5836 E BEVERLY BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900222824",
            "telephone_number": "323-726-0370",
            "fax_number": "323-726-0239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE DIABETES CARE MEDICAL CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-19",
        "last_updated": "2015-02-27",
        "status": "A",
        "authorized_official_last_name": "RODRIGUEZ",
        "authorized_official_first_name": "ALTAGRACIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "323-726-0370",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A33652",
            "primary": true
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "CA",
            "license": "A33652",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A336520",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1972600880",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.