Southland Renal Medical Group, Inc

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

SOUTHLAND RENAL MEDICAL GROUP, INC

Practice address

11480 Brookshire Ave
Suite 110
Downey, CA 90241

Phone

(562) 630-3111

Fax

(562) 630-3107

NPI assigned

Mar 13, 2007

Organization subpart

No

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

Authorized official

Name

Cora Fischman

Title

Coo

Phone

(562) 630-3111

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

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

• Southland Renal Medical Group, Inc

  • Nephrology Physician
  • Fountain Valley, CA
  • NPI 1134252679

  O20050718001019

  Same enrollment
• Southland Renal Medical Group, Inc

  • Nephrology Physician
  • Long Beach, CA
  • NPI 1447383971

  O20050718001019

  Same enrollment
• Southland Renal Medical Group, Inc

  • Nephrology Physician
  • Long Beach, CA
  • NPI 1851589600

  O20050718001019

  Same enrollment
• Southland Renal Medical Group, Inc.

  • Nephrology Physician
  • Los Alamitos, CA
  • NPI 1205969748

  O20050718001019

  Same enrollment
• Southland Renal Medical Group, Inc.

  • Nephrology Physician
  • Long Beach, CA
  • NPI 1730110495

  O20050718001019

  Same enrollment

Practitioners 5

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

• Antiem Bui, D.O.

  • Nephrology Physician
  • Lakewood, CA
  • NPI 1336569300
  NPD
• Michael Alan Fischman, M.D.

  • Nephrology Physician
  • Lakewood, CA
  • NPI 1710326558
  NPD
• Priyanka Vishwanath Gogte, MD

  • Internal Medicine Physician
  • Lakewood, CA
  • NPI 1518453422

  Nephrology

  NPD
• Elizabeth Joy Elder Sandy, PA

  • Physician Assistant
  • West Hollywood, CA
  • NPI 1285260745
  NPD
• Jeahee Jaycee Son, NP

  • Family Nurse Practitioner
  • Buena Park, CA
  • NPI 1114766425
  NPD

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720396800000",
    "number": "1992838429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3300 E SOUTH ST STE 308",
            "city": "LAKEWOOD",
            "state": "CA",
            "postal_code": "908054598",
            "telephone_number": "562-630-3111",
            "fax_number": "562-630-3107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11480 BROOKSHIRE AVE",
            "address_2": "SUITE 110",
            "city": "DOWNEY",
            "state": "CA",
            "postal_code": "90241",
            "telephone_number": "562-630-3111",
            "fax_number": "562-630-3107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAND RENAL MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2024-07-08",
        "certification_date": "2024-07-08",
        "status": "A",
        "authorized_official_last_name": "FISCHMAN",
        "authorized_official_first_name": "CORA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "562-630-3111"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0093373",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Briana Sousa, OTR/L
• Southern California Alcohol & Drug Programs, Inc.
• Southern California Alcohol and Drug Programs, Inc.
• Southern California Alcohol and Drug Programs, Inc.
• Southern California Rehabilitation Services, Inc.
• Gbenga S Sowunmi
• Lilli Specter
• Spectera
• William Spetnagel
• Jennifer C. Sri, M.D.

• Nephrology Physician in Downey, CA
• Providers in Downey, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2024; 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.