NPIMap

Organization Active NPI

Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Woodland Hills, CA
National Provider Identifier
1952333478
Registry record updated May 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice address
5601 De Soto Ave
Woodland Hills, CA 91367-6701
Phone
(818) 719-2000
NPI assigned
Jul 7, 2006
Last updated
May 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2021

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

Authorized official

Name
Dr. Ramin Davidoff, MD
Title
Executive Medical Director
Phone
(877) 608-0044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Primary

Addresses

Primary practice location

5601 De Soto Ave
Woodland Hills, CA 91367-6701

Mailing address

393 E Walnut St
3Rd FL PHR Group & Provider Enrollment
Pasadena, CA 91188-0001
Phone (626) 405-7914

Other identifiers 1

IdentifierTypeStateIssuer
GR0018331MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031110000678 CA Part B Supplier - Clinic/Group Practice 6002729175 Receives reassigned benefits from 14,591 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20260217001864 CA MDPP Supplier - in-Person MDPP Supplier With Distance Learning 6002729175 12 other NPIs on this enrollment

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

National Provider Directory

National Provider Directory

Locations

9333 Imperial Hwy
Downey, CA 90242
Phone (562) 657-8850

4760 W Sunset Blvd
Los Angeles, CA 90027
Phone (323) 783-0567

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

2601 E Main St
Ventura, CA 93003
Phone (805) 477-6350

Practitioners & affiliated clinicians

Practitioners 624

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 624

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622073600000",
    "number": "1952333478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "address_2": "3RD FL PHR GROUP & PROVIDER ENROLLMENT",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880001",
            "telephone_number": "626-405-7914",
            "fax_number": "626-405-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 DE SOTO AVE",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913676701",
            "telephone_number": "818-719-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-07",
        "last_updated": "2021-05-27",
        "certification_date": "2021-05-27",
        "status": "A",
        "authorized_official_last_name": "DAVIDOFF",
        "authorized_official_first_name": "RAMIN",
        "authorized_official_title_or_position": "EXECUTIVE MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "877-608-0044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0018331",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodland Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2021; 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.