Individual provider Active NPI

Paul Holtom, M.D.

  • Infectious Disease Physician
  • Los Angeles, CA
National Provider Identifier
1851300032
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
License
G044895 Issued in CA
Practice address
1520 San Pablo St
Suite 1000
Los Angeles, CA 90033-5310
Phone
(323) 442-5100
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease Physician 207RI0200X G044895 CA Primary

Addresses

Primary practice location

1520 San Pablo St
Suite 1000
Los Angeles, CA 90033-5310

Mailing address

Lac Usc Medical Center
1200 N. State SE. Room C5E100
Los Angeles, CA 90033
Phone (323) 409-6645

Other identifiers 13

IdentifierTypeStateIssuer
00G448950197OtherCACAL OPTIMA
W18762OtherCAGROUP MEDICARE
00G448950MedicaidCA
440000831OtherCARAILROAD MEDICARE
CE1617OtherCAGROUP RAILROAD MEDICARE
1902846306OtherCAGROUP NPI
GR0016910OtherCAGROUP MEDICAID PIN
W11675OtherCAGROUP MEDICARE PIN
ZZZ50018ZOtherCAGROUP BLUE SHIELD
00G448950OtherCABLUE SHIELD
06E2774OtherCAGROUP CHAMPUS
GR0100430OtherCAGROUP MEDICAL
1356390009OtherCAGROUP NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080112000158 CA Practitioner - Infectious DiseasePractitioner - Internal Medicine 1951482272 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
44895CAMDMarriage & Family Therapist
G044895CAMDInfectious Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Apr 1, 2009 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Apr 1, 2009 Accepting new patients
Usc Internal Medicine, Inc. Infectious Disease Past Accepting new patients

Locations

1441 Eastlake Ave
Los Angeles, CA 90089
Phone (323) 865-3000

1520 San Pablo St
Ste 1000
Los Angeles, CA 90033
Phone (626) 457-5839

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1851300032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "LAC USC MEDICAL CENTER",
            "address_2": "1200 N. STATE SE. ROOM C5E100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90033",
            "telephone_number": "323-409-6645",
            "fax_number": "323-441-8250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 SAN PABLO ST",
            "address_2": "SUITE 1000",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335310",
            "telephone_number": "323-442-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLTOM",
        "first_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2022-07-21",
        "certification_date": "2022-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Infectious Disease",
            "state": "CA",
            "license": "G044895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAL OPTIMA",
            "identifier": "00G448950197",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "W18762",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G448950",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "440000831",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP RAILROAD MEDICARE",
            "identifier": "CE1617",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1902846306",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAID PIN",
            "identifier": "GR0016910",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE PIN",
            "identifier": "W11675",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BLUE SHIELD",
            "identifier": "ZZZ50018Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00G448950",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP CHAMPUS",
            "identifier": "06E2774",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICAL",
            "identifier": "GR0100430",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1356390009",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.