Active NPI
Tom Ryan Demeester, MD
- Surgery Physician
- Los Angeles, CA
National Provider Identifier
1902837289
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- C42820
- Practice address
- 1510 San Pablo St
Suite 514
Los Angeles, CA 90033-5324 - Phone
- (323) 442-5910
- Fax
- (323) 442-6798
- NPI assigned
- Jul 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | C42820 | CA | Primary |
Addresses
Primary practice location
1510 San Pablo St
Suite 514
Los Angeles, CA 90033-5324
Mailing address
1510 San Pablo St
Suite 514
Los Angeles, CA 90033-5324
Phone (323) 442-5910
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00C428200 | Other | CA | BLUE SHIELD PIN |
| 020023696 | Other | CA | MEDICARE RAILROAD PIN |
| 00C428200C29 | Other | CA | CAL OPTIMA PIN |
| 00C428200 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C42820 | CA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Usc Surgeons, Inc. | Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Surgery Physician
- Los Angeles, CA
- NPI 1821034315
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255392000000",
"number": "1902837289",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1510 SAN PABLO ST",
"address_2": "SUITE 514",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900335324",
"telephone_number": "323-442-5910",
"fax_number": "323-442-6798"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1510 SAN PABLO ST",
"address_2": "SUITE 514",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900335324",
"telephone_number": "323-442-5910",
"fax_number": "323-442-6798"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMEESTER",
"first_name": "TOM",
"middle_name": "RYAN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2009-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "CA",
"license": "C42820",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PIN",
"identifier": "00C428200",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD PIN",
"identifier": "020023696",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAL OPTIMA PIN",
"identifier": "00C428200C29",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00C428200",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.