NPIMap

Organization Active NPI

Senior Care Clinic a Medical Corporation

  • Geriatric Medicine (Internal Medicine) Physician
  • Los Angeles, CA
National Provider Identifier
1942354857
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
License
A51085 Issued in CA
Legal business name
SENIOR CARE CLINIC A MEDICAL CORPORATION
Practice address
1700 Cesar Chavez Ave
# 3900
Los Angeles, CA 90033-2414
Phone
(323) 307-0800
Fax
(323) 307-0803
NPI assigned
Jan 22, 2007
Last updated
Jun 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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

Authorized official

Name
Dr. Azmy Fouad Ghaly, MEDICAL DOCTORNPI 1194899336
Title
President
Phone
(323) 307-0800

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X A51085 CA Primary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X A72860 CA
Geriatric Medicine (Internal Medicine) Physician 207RG0300X A77545 CA

Addresses

Primary practice location

1700 Cesar Chavez Ave
# 3900
Los Angeles, CA 90033-2414

Mailing address

1700 Cesar Chavez Ave
# 3900
Los Angeles, CA 90033-2414
Phone (323) 307-0800

Other identifiers 1

IdentifierTypeStateIssuer
GR0089680MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050330000367 CA Part B Supplier - Clinic/Group Practice 6103872403 Receives reassigned benefits from 12 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

1720 E Cesar E Chavez Ave
#271
Los Angeles, CA 90033

1720 E Cesar E Chavez Ave
Ste GZ271
Los Angeles, CA 90033
Phone (323) 307-8900

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1685923200000",
    "number": "1942354857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 CESAR CHAVEZ AVE",
            "address_2": "# 3900",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332414",
            "telephone_number": "323-307-0800",
            "fax_number": "323-307-0803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 CESAR CHAVEZ AVE",
            "address_2": "# 3900",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332414",
            "telephone_number": "323-307-0800",
            "fax_number": "323-307-0803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR CARE CLINIC A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A",
        "authorized_official_last_name": "GHALY",
        "authorized_official_first_name": "AZMY",
        "authorized_official_middle_name": "FOUAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-307-0800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MEDICAL DOCTOR"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A51085",
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A72860",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A77545",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0089680",
            "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 Jun 5, 2023; 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.