NPIMap

Organization Active NPI

Oceanside Medical Group, a Medical Corporation

  • Psychiatry Physician
  • Santa Monica, CA
National Provider Identifier
1861770513
Registry record updated Jul 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
OCEANSIDE MEDICAL GROUP, A MEDICAL CORPORATION
Practice address
701 Santa Monica Blvd
Suite 230
Santa Monica, CA 90401-2623
Phone
(310) 993-4103
Fax
(805) 494-8385
NPI assigned
Jul 29, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2011

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

Authorized official

Name
Gadson J Johnson, M.D.NPI 1578767232
Title
President
Phone
(310) 993-4103

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Geriatric Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0805X

Addresses

Primary practice location

701 Santa Monica Blvd
Suite 230
Santa Monica, CA 90401-2623

Mailing address

701 Santa Monica Blvd
Suite 230
Santa Monica, CA 90401-2623
Phone (310) 993-4103

Other identifiers 1

IdentifierTypeStateIssuer
FNP41555OtherCAFNP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110930000204 CA Part B Supplier - Clinic/Group Practice 9335311042 Receives reassigned benefits from 22 practitioners

National Provider Directory

National Provider Directory

Locations

1135 N Leisure Ct
Anaheim, CA 92801
Phone (714) 772-1353

4938 Clara St
Cudahy, CA 90201
Phone (562) 209-8628

5001 E Anaheim St
Long Beach, CA 90804
Phone (562) 494-5001

4807 S Normandie Ave
Los Angeles, CA 90037
Phone (213) 572-8768

831 S Lake St
Los Angeles, CA 90057
Phone (213) 380-9175

6525 Rosemead Blvd
Pico Rivera, CA 90660
Phone (562) 801-2268

701 Santa Monica Blvd
Ste 230
Santa Monica, CA 90401
Phone (310) 993-4103

1025 N Fairfax Ave
West Hollywood, CA 90046
Phone (323) 656-7900

Practitioners & affiliated clinicians

Practitioners 28

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

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1311897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311897600000",
    "number": "1861770513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 SANTA MONICA BLVD",
            "address_2": "SUITE 230",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904012623",
            "telephone_number": "310-993-4103",
            "fax_number": "805-494-8385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 SANTA MONICA BLVD",
            "address_2": "SUITE 230",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904012623",
            "telephone_number": "310-993-4103",
            "fax_number": "805-494-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEANSIDE MEDICAL GROUP, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-29",
        "last_updated": "2011-07-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "GADSON",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-993-4103",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FNP",
            "identifier": "FNP41555",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2011; 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.