NPIMap

Organization Active NPI

Pacific Shores Medical Group, Inc.

  • Hematology & Oncology Physician
  • Glendale, CA
National Provider Identifier
1871642991
Registry record updated Apr 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
PACIFIC SHORES MEDICAL GROUP, INC.
Practice address
222 W Eulalia St
#100-B
Glendale, CA 91204-2849
Phone
(818) 637-7611
NPI assigned
Jan 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2016

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

Authorized official

Name
Nerses Simon Tchekmedyian, M.D.NPI 1821032129
Title
Ceo
Phone
(562) 590-0345

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X Primary

Addresses

Primary practice location

222 W Eulalia St
#100-B
Glendale, CA 91204-2849

Mailing address

1043 Elm Ave
Ste 104
Long Beach, CA 90813-3271
Phone (562) 590-0345

Other identifiers 1

IdentifierTypeStateIssuer
GR0065541MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040417000523 CA Part B Supplier - Clinic/Group Practice 0749275808 Receives reassigned benefits from 30 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Irvine, CA; Torrance, CA; Newport Beach, CA; Long Beach, CA; Huntington Beach, CA; Glendale, 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

19582 Beach Blvd
Ste 212
Huntington Beach, CA 92648
Phone (714) 252-9415

16300 Sand Canyon Ave
Ste 207
Irvine, CA 92618
Phone (714) 252-9415

Practitioners & affiliated clinicians

Practitioners 29

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.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460419200000",
    "number": "1871642991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1043 ELM AVE",
            "address_2": "STE 104",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908133271",
            "telephone_number": "562-590-0345",
            "fax_number": "562-437-8139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W EULALIA ST",
            "address_2": "#100-B",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042849",
            "telephone_number": "818-637-7611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC SHORES MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2016-04-12",
        "status": "A",
        "authorized_official_last_name": "TCHEKMEDYIAN",
        "authorized_official_first_name": "NERSES",
        "authorized_official_middle_name": "SIMON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "562-590-0345",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0065541",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; 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.