NPIMap

Prohealth Partners a Medical Group

Organization Active NPI Family Medicine Physician · Cudahy, CA

NPI 1922495076 · NPPES record last updated Jan 29, 2019

Key facts

NPI
1922495076
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
PROHEALTH PARTNERS A MEDICAL GROUP
Practice address
7643 Atlantic Ave
Cudahy, CA 90201
Phone
(323) 771-1713
Fax
(323) 562-1302
NPI assigned
Apr 15, 2015
Organization subpart
No

Authorized official

Name
Barry Steven Allswang, MD
Title
President
Phone
(562) 299-5200

Corporate family (same tax ID) 20

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 3

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2114311Prohealth Partners a Medical Group Inc
7643 S Atlantic Ave, Cudahy, CA 90201		Certificate of waiverJun 9, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031211000927 CA Part B Supplier - Clinic/Group Practice 2769388412 Receives reassigned benefits from 296 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Prohealth Partners a M (63 organizations share this tax ID)

Locations

3325 Palo Verde Ave
Ste 2
Long Beach, CA 90808

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD
    Plans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X

Addresses

Primary practice location

7643 Atlantic Ave
Cudahy, CA 90201

Mailing address

7643 Atlantic Ave
Cudahy, CA 90201-5019
Phone (323) 771-1713

Other names

  • Clinica Santa Clara Medical Clinic Doing business as

Other providers in Cudahy, CA

All providers in Cudahy, CA · Family Medicine Physician in California

Sources for this page

Verify at the official NPI Registry.