DAVID A SACK MD A PROFESSIONAL MEDICAL CORPORATION (NPI# 1104377613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104377613 |
| Entity Type | Organization |
| Organization Name | DAVID A SACK MD A PROFESSIONAL MEDICAL CORPORATION |
| Other Organization Name | ELEMENTS MEDICAL GROUP |
| Practice Address |
20786 Cool Oak Way Malibu CA 90265-5318 |
| Mailing Address |
Po Box 671387 Dallas TX 75267-1387 |
| Practice Telephone | 4242352337 |
| Practice Fax Number | 3109430438 |
| Mailing Telephone | 6155677282 |
| Mailing Fax Number | 6152618912 |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2017-01-24 |
| Authorized Official Name | MRS. CHERYL MAPLESDEN (SR DIRECTOR RCM) |
| Authorized Official Telephone | 6155403708 |
| Authorized Official Credential | CPC,CHC,CHPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
Allopathic & Osteopathic Physicians | ||
| Y | 2084P0802X |
Psychiatry & Neurology Specialization: Addiction Psychiatry |
20A13416 | CA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Elements Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992243935 | David A Sack Md A Professional Medical Corporation | Psychiatry & Neurology | 3743 S Barrington Ave, Los Angeles, CA 90066-3218 | 2017-02-10 |
| 1457899494 | David A Sack Md A Professional Medical Corporation | Psychiatry & Neurology | 20725 Rockcroft Dr, Malibu, CA 90265-5343 | 2017-02-10 |
| 1811446768 | David A Sack Md A Professional Medical Corporation | Internal Medicine | 2515 Wilshire Blvd, Santa Monica, CA 90403-4615 | 2016-10-03 |
| Street Address |
20786 COOL OAK WAY |
| City | MALIBU |
| State | CA |
| Zip Code | 90265-5318 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053898445 | Pb California Rehab and Recovery, LLC | Substance Abuse Rehabilitation Facility | 20786 Cool Oak Way, Malibu, CA 90265-5318 | 2018-07-27 |
| 1669923124 | Westside Sober Living Centers, Inc | Psychiatric Residential Treatment Facility | 20786 Cool Oak Way, Malibu, CA 90265-5318 | 2016-10-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649884909 | Montage Recovery Ca LLC | Psychiatric Residential Treatment Facility | 2890 Kana Dume, Malibu, CA 90265 | 2020-09-03 |
| 1912518887 | Oconnor Optometric Inc | Optometrist | 23401 Civic Center Way, Unit 2b, Malibu, CA 90265 | 2020-08-13 |
| 1184234593 | Jessica Gash | Student in an Organized Health Care Education/Training Program | 24420 Tiner Court, Malibu, CA 90265 | 2020-07-31 |
| 1902438393 | Montage Recovery Ca, LLC | Clinic/Center | 2890 Kanan Dume Road, Malibu, CA 90265 | 2020-02-04 |
| 1164909032 | Joseph Turcillo | Internal Medicine | 3065 Malibu Country Dr, Malibu, CA 90265 | 2018-07-24 |
| 1356830657 | Samantha Erin Schlossmann | Clinical Neuropsychologist | 28348 Rey De Copas Lane, Malibu, CA 90265 | 2018-05-02 |
| 1740783653 | Adam Dov Greenberg | Acupuncturist | 5853 Filaree Hts., Malibu, CA 90265 | 2018-03-16 |
| 1225556673 | Jeff Harris, M.d. A Medical Corporation | Pediatrics | 23805 Stuart Ranch Rd. #310, Malibu, CA 90265 | 2017-09-06 |
| 1184177347 | Michael J. Maguire Acupuncturist, Inc. | Acupuncturist | 28990 PCh, Building B Ste 211, Malibu, CA 90265 | 2016-07-25 |
| 1093182198 | Recovery Malibu, Inc. | Substance Abuse Rehabilitation Facility | 20723 Rockcroft Dr., Malibu, CA 90265 | 2015-08-25 |
| Find all providers in zip 90265 | ||||
| Taxonomy Code | 2084P0802X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Addiction Psychiatry |
| Addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457899494 | David A Sack Md A Professional Medical Corporation | Psychiatry & Neurology | 20725 Rockcroft Dr, Malibu, CA 90265-5343 | 2017-02-10 |
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| 1912362567 | Sanjoy Sathpathy, M.d. Inc | Psychiatry & Neurology | 9888 Carroll Center Road, 218, San Diego, CA 92126-4515 | 2015-12-28 |
| 1043562630 | San Diego Professional Group, P. C. | Psychiatry & Neurology | 41655 Date St, Suite 101a, Murrieta, CA 92562-7040 | 2012-10-08 |
| 1841591690 | David E. Brody | Psychiatry & Neurology | 13200 South Bloomfield Ave, Norwalk, CA 90650 | 2010-11-10 |
| 1124342647 | Vicki Kalira | Psychiatry & Neurology | 150 Muir Rd Bldg 24, Martinez, CA 94553-4668 | 2010-03-26 |
| 1710127964 | Pacific Composure Psychiatry & Hypnotherapy | Psychiatry & Neurology | 180 7th Ave Ste 103, Santa Cruz, CA 95062-4732 | 2009-02-28 |
| 1235341330 | Timmen Cermak | Psychiatry & Neurology | 239 Miller Avenue, Suite #1, Mill Valley, CA 94941 | 2007-05-03 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.