NPIMap

Organization Active NPI

Innovative Medical Solutions Inc a Medical Group

  • Adolescent Medicine (Internal Medicine) Physician
  • Panorama City, CA
National Provider Identifier
1972624955
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X
License
G78454 Issued in CA
Legal business name
INNOVATIVE MEDICAL SOLUTIONS INC A MEDICAL GROUP
Practice address
14860 Roscoe Blvd Ste 200
Panorama City, CA 91402-4683
Phone
(310) 553-5203
NPI assigned
Apr 3, 2007
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

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

Authorized official

Name
Dr. Glenn A Marshak, M.D.NPI 1104890029
Title
Owner
Phone
(310) 553-5203

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adolescent Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0000X G78454 CA Primary

Addresses

Primary practice location

14860 Roscoe Blvd Ste 200
Panorama City, CA 91402-4683

Mailing address

PO Box 15655
Beverly Hills, CA 90209-1655
Phone (310) 553-5203

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050107000871 CA Part B Supplier - Clinic/Group Practice 5294783080 Receives reassigned benefits from 103 practitioners
Practice locations: Chula Vista, CA; Beverly Hills, CA; Tarzana, CA; Panorama City, CA; Los Angeles, CA; Gardena, CA; Garden Grove, CA; Culver City, CA…
O20211014001394 CA DME Supplier - Physician - Internal Medicine 5294783080 Practice locations: Panorama City, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2267988Innovative Medical Solutions14860 Roscoe Blvd Ste 200, Panorama City, CA 91402Certificate of waiverSep 1, 2026

National Provider Directory

National Provider Directory

Locations

1125 S Beverly Dr
Ste 611
Los Angeles, CA 90035
Phone (310) 553-7049

11340 W Olympic Blvd
Ste 205
Los Angeles, CA 90064
Phone (310) 268-7880

1711 W Temple St
Fl 6
Los Angeles, CA 90026
Phone (213) 483-2160

2080 Century Park E
Ste 1702
Los Angeles, CA 90067
Phone (310) 201-0731

14850 Roscoe Blvd
Ste 200
Panorama City, CA 91402

14860 Roscoe Blvd
Ste 108
Panorama City, CA 91402
Phone (818) 904-3635

9836 Atlantic Ave
South Gate, CA 90280
Phone (213) 249-0707

Practitioners & affiliated clinicians

Practitioners 112

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 112

NPI Registry JSON

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1972624955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15655",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902091655",
            "telephone_number": "310-553-5203",
            "fax_number": "310-659-0933"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14860 ROSCOE BLVD STE 200",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914024683",
            "telephone_number": "310-553-5203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE MEDICAL SOLUTIONS INC A MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-03",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "MARSHAK",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-553-5203",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RA0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "CA",
            "license": "G78454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panorama City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.