Paul J Grodan M.D. a Professional Corporation

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

G30279 Issued in CA

Legal business name

PAUL J GRODAN M.D. A PROFESSIONAL CORPORATION

Practice address

150 N Robertson Blvd
Suite 211
Beverly Hills, CA 90211-2142

Phone

(310) 854-0100

Fax

(310) 659-3297

NPI assigned

Mar 2, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Paul John Grodan, M.D.NPI 1861500662

Title

President

Phone

(310) 854-0100

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Paul John Grodan, M.D.

  • Cardiovascular Disease Physician
  • Beverly Hills, CA
  • NPI 1861500662

  O20100323000239

  Same enrollment

Locations

Practitioners 1

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

• Paul John Grodan, M.D.

  • Cardiovascular Disease Physician
  • Beverly Hills, CA
  • NPI 1861500662
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1267488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1267488000000",
    "number": "1982927174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N ROBERTSON BLVD",
            "address_2": "SUITE 211",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902112142",
            "telephone_number": "310-854-0100",
            "fax_number": "310-659-3297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 N ROBERTSON BLVD",
            "address_2": "SUITE 211",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902112142",
            "telephone_number": "310-854-0100",
            "fax_number": "310-659-3297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL J GRODAN M.D. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-02",
        "last_updated": "2010-03-02",
        "status": "A",
        "authorized_official_last_name": "GRODAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-854-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "G30279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G302790",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-TYPE UNSPECIFIED",
            "identifier": "G30279",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Cardiovascular Disease Physician in Beverly Hills, CA
• Providers in Beverly Hills, CA by specialty
• Cardiovascular Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2010; 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.