Innovative Medical Solutions Inc a Medical Group
Organization Active NPI Adolescent Medicine (Internal Medicine) Physician · Panorama City, CA
NPI 1972624955 · NPPES record last updated Sep 18, 2024
Key facts
- NPI
- 1972624955
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Adolescent Medicine (Internal Medicine) Physician 207RA0000X
- License
- G78454 (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
- Organization subpart
- No
Authorized official
- Name
- Dr. Glenn A Marshak, M.D.
- Title
- Owner
- Phone
- (310) 553-5203
Practitioners 112
-
Emily Katherine Ackerman, M.D.
-
James E. Burrows, M.D.
-
Nicole Comfort, NP
-
Saira M Dar, MD
-
Rajesh Laxmi Gade, M.D.
-
Anirudh Gupta, MD, PHD
-
Tarek I. Hassanein, M.D.
-
Layli Jamali, M.D.
-
Michael B Kamiel, MD
-
Steven Khoubian, M.D.
-
Jason P Lee, MD
-
Jonathan C Leiterman, SC.D
-
Lilit Pilossyan, MD
-
Adriana Ponce, FNP
-
Evan G Rosen, M.D.
-
Lawrence R Rouben, M.D.
-
Alex Sahba, MD
-
Rafik M Sidrak, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2267988 | Innovative Medical Solutions | Certificate of waiver | Sep 1, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
Locations
11340 W Olympic Blvd
Ste 205
Los Angeles, CA 90064
Phone (310) 268-7880
2080 Century Park E
Ste 1702
Los Angeles, CA 90067
Phone (310) 201-0731
2080 Century Park E
Ste 707
Los Angeles, CA 90067
Phone (310) 553-0123
2080 Century Park E
Los Angeles, CA 90067
Phone (310) 229-1220
1711 W Temple St
Fl 6
Los Angeles, CA 90026
Phone (213) 483-2160
14860 Roscoe Blvd
Ste 108
Panorama City, CA 91402
Phone (818) 904-3635
14850 Roscoe Blvd
Ste 200
Panorama City, CA 91402
9836 Atlantic Ave
South Gate, CA 90280
Phone (213) 249-0707
23101 Sherman Pl
Ste 407
West Hills, CA 91307
Phone (818) 999-3800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Adolescent Medicine (Internal Medicine) Physician |
207RA0000X | G78454 | CA | Yes |
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
Other providers in Panorama City, CA
- Shawn John Iftikar
- Ihelp Hospice Inc
- Ilya Alayev DDS PC
- Jennifer Im
- Inclusive and Extensive Autism Services
- Integral Home Health Care, Inc.
- International Pre-Diabetes Center Inc
- International Pre-Diabetes Center Inc
- Ioan Recovery & Wellness Center
- David L. Isagholian
All providers in Panorama City, CA · Adolescent Medicine (Internal Medicine) Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.