NPIMap

Individual provider Active NPI

Alfonso Brigham, M.D.

  • Internal Medicine Physician
  • Hawthorne, CA
National Provider Identifier
1902858343
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G48631 Issued in CA
Practice address
11633 Hawthorne Blvd
Suite 410
Hawthorne, CA 90250-2321
Phone
(310) 792-4450
Fax
(310) 792-4455
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G48631 CA Primary

Addresses

Primary practice location

11633 Hawthorne Blvd
Suite 410
Hawthorne, CA 90250-2321

Mailing address

4161 Redondo Beach Blvd
Suite 201
Lawndale, CA 90260-3306
Phone (310) 214-8677

Other identifiers 1

IdentifierTypeStateIssuer
00G486310MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address abrigham191888@oc.providencedirect.org

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
I20060215000859 CA Practitioner - Internal Medicine 5294740916 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Un of California, Irvine, College of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Laguna Niguel, CA 92677

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G48631CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Institute Internal Medicine CurrentSince Nov 1, 2007 Accepting new patients
Providence Medical Institute Internal Medicine CurrentSince Nov 1, 2007 Accepting new patients
Prairie Medical Group Past Accepting new patients
La Vida Medical & Ipa Past Accepting new patients
La Vida Multispecialty Medical Group Inc Past Accepting new patients
Prime Healthcare Centinela, LLC Past Accepting new patients

Locations

12618 Hawthorne Blvd
Hawthorne, CA 90250
Phone (310) 263-5700

11633 Hawthorne Blvd
Ste 410
Hawthorne, CA 90250
Phone (310) 792-4450

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: abrigham191888@oc.providencedirect.org

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1902858343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4161 REDONDO BEACH BLVD",
            "address_2": "SUITE 201",
            "city": "LAWNDALE",
            "state": "CA",
            "postal_code": "902603306",
            "telephone_number": "310-214-8677",
            "fax_number": "310-921-1718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11633 HAWTHORNE BLVD",
            "address_2": "SUITE 410",
            "city": "HAWTHORNE",
            "state": "CA",
            "postal_code": "902502321",
            "telephone_number": "310-792-4450",
            "fax_number": "310-792-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRIGHAM",
        "first_name": "ALFONSO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2023-03-07",
        "certification_date": "2021-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G48631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G486310",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "abrigham191888@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "12618 Hawthorne Blvd",
            "city": "Hawthorne",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902503907",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hawthorne, CA

Sources for this page

Verify at the official NPI Registry.