NPIMap

Organization Active NPI

Pacific Health Medical Group

  • Adolescent and Children Mental Health Clinic/Center
  • Glendale, CA
National Provider Identifier
1902209992
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
License
A113904 Issued in CA
Legal business name
PACIFIC HEALTH MEDICAL GROUP
Practice address
319 S Brand Blvd
Glendale, CA 91204-1701
Phone
(818) 240-0006
Fax
(818) 240-0038
NPI assigned
Oct 3, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Authorized official

Name
Dr. Gayane Begoyan, M.D.NPI 1427210954
Title
Medical Doctor
Phone
(818) 240-0006

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
Adult Mental Health Clinic/Center 261QM0850X A113904 CA
Adolescent and Children Mental Health Clinic/Center 261QM0855X A113904 CA Primary

Addresses

Primary practice location

319 S Brand Blvd
Glendale, CA 91204-1701

Mailing address

319 S Brand Blvd
Glendale, CA 91204-1701
Phone (818) 240-0006

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150330000009 CA Part B Supplier - Clinic/Group Practice 4183941222 Receives reassigned benefits from 7 practitioners
Practice locations: Glendale, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1412294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1902209992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 S BRAND BLVD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041701",
            "telephone_number": "818-240-0006",
            "fax_number": "818-240-0038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "319 S BRAND BLVD",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912041701",
            "telephone_number": "818-240-0006",
            "fax_number": "818-240-0038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC HEALTH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-03",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "BEGOYAN",
        "authorized_official_first_name": "GAYANE",
        "authorized_official_title_or_position": "MEDICAL DOCTOR",
        "authorized_official_telephone_number": "818-240-0006",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "A113904",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "CA",
            "license": "A113904",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Oct 3, 2014; 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.