NPIMap

Individual provider Active NPI

Gilmore Chung, M.D.

  • Internal Medicine Physician
  • Venice, CA
National Provider Identifier
1992027072
Registry record updated Mar 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A111111 Issued in CA
Practice address
604 Rose Ave
Venice, CA 90291-2767
Phone
(310) 392-8636
Fax
(310) 392-6642
NPI assigned
Feb 17, 2010
Sex
Male
Sole proprietor
No

Organizations & group practices 17

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.

View all 17

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Kentucky College of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Venice Family Clinic 101 clinicians

Practice addresses (Care Compare)

604 Rose Ave
Venice, CA 90291-2767
Phone (310) 664-7901

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
I20121109000465 CA Practitioner - Internal MedicinePractitioner - Pediatric Medicine 2961653472 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles (5 of 6)

OrganizationSpecialtyStatusNew patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic CurrentSince Sep 8, 2015 Accepting new patients
Venice Family Clinic Current Accepting new patients
Venice Family Clinic CurrentSince Sep 8, 2015 Accepting new patients
Venice Family Clinic Current Accepting new patients

Locations

4700 Inglewood Blvd
Ste 102
Los Angeles, CA 90230
Phone (310) 664-7901

2509 Pico Blvd
Santa Monica, CA 90405
Phone (310) 664-7901

905 Venice Blvd
Venice, CA 90291
Phone (310) 392-8630

604 Rose Ave
Venice, CA 90291
Phone (310) 392-8630

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: gchung753297@direct.ochin.org

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A111111 CA Primary

Addresses

NPPES NPI Registry

Primary practice location

604 Rose Ave
Venice, CA 90291-2767

Mailing address

604 Rose Ave
Venice, CA 90291-2767
Phone (310) 392-8636

Other identifiers 3

NPPES NPI Registry
IdentifierTypeStateIssuer
1902846306OtherCAGROUP NPI
W18762OtherCAGROUP MEDICARE
GR0100430OtherCAGROUP MEDI-CAL

Electronic endpoints 1

NPPES NPI Registry
TypeEndpointUseAffiliation
Direct Messaging Address gilmore.chung.p1@direct.venicefamilyclinic.nextgenshare.com Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 10, 2021.

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1992027072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "604 ROSE AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912767",
            "telephone_number": "310-392-8636",
            "fax_number": "310-392-6642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 ROSE AVE",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912767",
            "telephone_number": "310-392-8636",
            "fax_number": "310-392-6642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHUNG",
        "first_name": "GILMORE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-17",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A111111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1902846306",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE",
            "identifier": "W18762",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDI-CAL",
            "identifier": "GR0100430",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gilmore.chung.p1@direct.venicefamilyclinic.nextgenshare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "604 Rose Ave",
            "city": "Venice",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902912767",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Venice, CA

Sources for this page

Verify at the official NPI Registry.