Southern California Permanente Medical Group

Organization Active NPI Health Maintenance Organization · Lancaster, CA

NPI 1982863783 · NPPES record last updated May 27, 2021

Key facts

NPI
1982863783
Entity type
Organization (NPI type 2)
Primary specialty
Health Maintenance Organization 302R00000X
Legal business name
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Practice address
43112 N 15TH St
Lancaster, CA 93534-6219
Phone
(661) 726-2279
NPI assigned
Jun 6, 2008
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 24

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

Practitioners 611

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 611

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in CA

Medicare enrollment records

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
This NPI is an additional NPI on the enrollment

National Provider Directory

Locations

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

126 W Del Mar Blvd
Pasadena, CA 91105
Phone (323) 224-7111

365 E Hillcrest Dr
Thousand Oaks, CA 91360
Phone (805) 374-7551

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Yes

Addresses

Primary practice location

43112 N 15TH St
Lancaster, CA 93534-6219

Mailing address

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

Electronic endpoints

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

Other providers in Lancaster, CA

All providers in Lancaster, CA · Health Maintenance Organization in California

Sources for this page

Verify at the official NPI Registry.