NPIMap

Individual provider Active NPI

David Wallenstein

  • Family Medicine Physician
  • Santa Monica, CA
National Provider Identifier
1962417386
Registry record updated Nov 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A81052 Issued in CA
Practice address
1920 Colorado Ave
Santa Monica, CA 90404-3414
Phone
(310) 319-4700
Fax
(310) 453-5106
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A81052 CA
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X A81052 CA
Family Medicine Physician 207Q00000X A81052 CA Primary

Addresses

Primary practice location

1920 Colorado Ave
Santa Monica, CA 90404-3414

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other identifiers 1

IdentifierTypeStateIssuer
00A810520MedicaidCA

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
I20040331001726 CA Practitioner - Family Practice 9537151378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
UC RegentsGroup PAC ID 9739083866, 36 clinicians

Practice addresses (Care Compare)

1920 Colorado Ave
Santa Monica, CA 90404-3414
Phone (310) 319-4700

Hospital & facility affiliations

  • Western States Homehealth Care Agency, Inc Home health agency, Los Angeles, CA, CCN 058097
  • St Luke Home Health Care, Inc Home health agency, Glendale, CA, CCN 059339
  • Accentcare UCLA Health, LLC Home health agency, West Hills, CA, CCN 057761
  • Ronald Reagan UCLA Medical Center Hospital, Los Angeles, CA, CCN 050262
  • Santa Monica - UCLA Med Ctr & Orthopaedic Hospital Hospital, Santa Monica, CA, CCN 050112

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A81052CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents Family Medicine CurrentSince Apr 1, 2004 Accepting new patients
UCLA Medical Group Family Medicine Past Accepting new patients
Regents Univ of Calif Los Angeles Past Accepting new patients
UCLA Family Practice Family Medicine Past Accepting new patients
The Regents of the University of California Past Accepting new patients

Locations

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

File 2939
Los Angeles, CA 90074
Phone (310) 794-6596

1920 Colorado Ave
Santa Monica, CA 90404
Phone (310) 319-4700

Interoperability endpoints

  • Direct secure messaging: dwallenstein53707@direct.uclahealth.org

Organizations & group practices 5

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 5

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": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574640000000",
    "number": "1962417386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1920 COLORADO AVE",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904043414",
            "telephone_number": "310-319-4700",
            "fax_number": "310-453-5106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLENSTEIN",
        "first_name": "DAVID",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2019-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A81052",
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "CA",
            "license": "A81052",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A81052",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A810520",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.