NPIMap

Organization Active NPI

Southland Renal Medical Group, Inc

  • Nephrology Physician
  • Long Beach, CA
National Provider Identifier
1851589600
Registry record updated Dec 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A46344 Issued in CA
Legal business name
SOUTHLAND RENAL MEDICAL GROUP, INC
Practice address
1045 Atlantic Ave
Suite 902
Long Beach, CA 90813-3408
Phone
(562) 630-3111
NPI assigned
Oct 5, 2007
Last updated
Dec 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2019

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

Authorized official

Name
Cora Fischman
Title
Coo
Phone
(562) 630-3111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X A46344 CA Primary

Addresses

Primary practice location

1045 Atlantic Ave
Suite 902
Long Beach, CA 90813-3408

Mailing address

3300 E South St Ste 308
Lakewood, CA 90805-4598
Phone (562) 630-3111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050718001019 CA Part B Supplier - Clinic/Group Practice 3476580838 Receives reassigned benefits from 9 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Downey, CA; Lakewood, CA; Los Alamitos, CA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

3300 E South St
Ste 308
Lakewood, CA 90805

3650 South St
Ste 301
Lakewood, CA 90712

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1191542400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575244800000",
    "number": "1851589600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST STE 308",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "908054598",
            "telephone_number": "562-630-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 ATLANTIC AVE",
            "address_2": "SUITE 902",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133408",
            "telephone_number": "562-630-3111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND RENAL MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-05",
        "last_updated": "2019-12-02",
        "status": "A",
        "authorized_official_last_name": "FISCHMAN",
        "authorized_official_first_name": "CORA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "562-630-3111"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A46344",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2019; 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.

Verify at the official NPI Registry.