NPIMap

Organization Active NPI

De la Pena Eye Clinic, a Medical Group, Inc

Doing business as De La Pena Eye Clinic, AMG, Inc

  • Ophthalmology Physician
  • Van Nuys, CA
National Provider Identifier
1952748501
Registry record updated Feb 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
DE LA PENA EYE CLINIC, A MEDICAL GROUP, INC
Doing business as
De La Pena Eye Clinic, AMG, Inc
Practice address
7100 Van Nuys Blvd
Suite 120
Van Nuys, CA 91405-3063
Phone
(818) 988-1111
Fax
(818) 988-1261
NPI assigned
May 22, 2013
Last updated
Feb 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2020

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

Authorized official

Name
Mark Kelly
Title
Member, Board of Managers
Phone
(615) 345-6900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU
Ophthalmology Physician 207W00000X NU Primary

Addresses

Primary practice location

7100 Van Nuys Blvd
Suite 120
Van Nuys, CA 91405-3063

Mailing address

401 Commerce St Ste 600
Nashville, TN 37219-2518
Phone (615) 345-6900

Other names 1

  • De La Pena Eye Clinic, AMG, Inc Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031223000882 CA Part B Supplier - Clinic/Group Practice 2961300116 Receives reassigned benefits from 36 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Huntington Park, CA; Whittier, CA; Van Nuys, CA; Santa Ana, CA; Montebello, CA; Los Angeles, CA; Long Beach, CA; El Monte, CA

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory

Locations

1760 Termino Ave
Ste 306
Long Beach, CA 90804

139 S Alvarado St
Los Angeles, CA 90057
Phone (213) 484-0170

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581984000000",
    "number": "1952748501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 COMMERCE ST STE 600",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192518",
            "telephone_number": "615-345-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7100 VAN NUYS BLVD",
            "address_2": "SUITE 120",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914053063",
            "telephone_number": "818-988-1111",
            "fax_number": "818-988-1261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE LA PENA EYE CLINIC, A MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2020-02-18",
        "certification_date": "2020-02-18",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MEMBER, BOARD OF MANAGERS",
        "authorized_official_telephone_number": "615-345-6900"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "De La Pena Eye Clinic, AMG, Inc",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "De La Pena Eye Clinic, AMG, Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Van Nuys, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2020; 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.