NPIMap

Individual provider Active NPI

Jose L. Pantoja, M.D.

  • Specialist
  • Lakewood, CA
National Provider Identifier
1891721353
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
C43031 Issued in CA
Practice address
5750 Downey Ave
Suite 202
Lakewood, CA 90712-1405
Phone
(562) 634-4939
Fax
(562) 634-5809
NPI assigned
Jun 24, 2006
Last updated
Nov 13, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X C43031 CA Primary

Addresses

Primary practice location

5750 Downey Ave
Suite 202
Lakewood, CA 90712-1405

Mailing address

PO Box 666
Artesia, CA 90702-0666
Phone (562) 634-4939

Other identifiers 2

IdentifierTypeStateIssuer
00C430310MedicaidCA
C43031OtherCAMEDICAL LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040213000229 CA Practitioner - GastroenterologyPractitioner - Internal Medicine 5294629705 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
Other, 1974
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5750 Downey Ave
Suite 202
Lakewood, CA 90712-1470
Phone (562) 634-4939

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy49
Upper gastrointestinal (GI) endoscopy for acid reflux61

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C43031CAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Partners, a Medical Group Current Accepting new patients
Prohealth Partners, a Medical Group Gastroenterology CurrentSince Oct 1, 2020 Accepting new patients
Kamali Medical Corporation Specialist CurrentSince Nov 30, 2006 Accepting new patients
Prohealth Partners, a Medical Group, Inc. CurrentSince Oct 1, 2020 Accepting new patients
Garden Grove Surgical Center Inc CurrentSince Nov 16, 2009 Accepting new patients
University of California Irvine Past Accepting new patients
Ray Gokaldas MD a Professional Corporation Specialist PastSince Aug 22, 2014 Accepting new patients
Prohealth Partners, a Medical Group, Inc. Past Accepting new patients
Tri-City Hospital Past Accepting new patients
Regents Univ of Calif Los Angeles Past Accepting new patients

Locations

5750 Downey Ave
Ste 202
Lakewood, CA 90712
Phone (562) 461-8584

1050 Linden Ave
Long Beach, CA 90813
Phone (562) 491-9000

3801 Katella Ave
Ste 330
Los Alamitos, CA 90720
Phone (562) 594-9546

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 10

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194912000000",
    "number": "1891721353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 666",
            "city": "ARTESIA",
            "state": "CA",
            "postal_code": "907020666",
            "telephone_number": "562-634-4939",
            "fax_number": "562-634-5809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5750 DOWNEY AVE",
            "address_2": "SUITE 202",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "907121405",
            "telephone_number": "562-634-4939",
            "fax_number": "562-634-5809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANTOJA",
        "first_name": "JOSE",
        "middle_name": "L.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2007-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "C43031",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C430310",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "C43031",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, CA

Sources for this page

Verify at the official NPI Registry.