PACIFIC MEDICAL GROUP (NPI# 1104430669) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104430669 |
| Entity Type | Organization |
| Organization Name | PACIFIC MEDICAL GROUP |
| Practice Address |
5450 Lincoln Blvd Playa Vista CA 90094-2002 |
| Mailing Address |
4712 Admiralty Way # 574 Marina Del Rey CA 90292-6905 |
| Practice Telephone | 3103059200 |
| Practice Fax Number | 3103052800 |
| Mailing Telephone | 3103059200 |
| Mailing Fax Number | 3103052800 |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2020-09-02 |
| Authorized Official Name | SAMSON YIRGU (MANAGER) |
| Authorized Official Telephone | 3103059200 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417165606 | Pacific Medical Group | General Practice | 3201 F St Ste 250, Bakersfield, CA 93301-1846 | 2007-05-19 |
| 1841465150 | Pacific Medical Group | Internal Medicine | 48 N El Molino Ave, Suite 201, Pasadena, CA 91101-1861 | 2008-04-28 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | PACIFIC MEDICAL GROUP | 2460 Sw Perkins Ave, Pendleton, OR 97801 |
| System for Award Management (SAM) Entities | PACIFIC MEDICAL GROUP, INC. | 212 Avenida Fabricante, San Clemente, CA 92672-7538 |
| Street Address |
5450 LINCOLN BLVD |
| City | PLAYA VISTA |
| State | CA |
| Zip Code | 90094-2002 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437784873 | Yeranui Stepanyan | Nurse Practitioner | 5450 Lincoln Blvd, Playa Vista, CA 90094-2002 | 2020-03-05 |
| 1972025948 | Silicon Beach Surgery Center Inc | Clinic/Center | 5450 Lincoln Blvd, Playa Vista, CA 90094-2002 | 2017-07-12 |
| 1689100745 | Playa Medical Management LLC | Prevention Professional | 5450 Lincoln Blvd, Playa Vista, CA 90094-2002 | 2017-05-11 |
| 1285168955 | Marina Nikiforova | Chiropractor | 5450 Lincoln Blvd, Playa Vista, CA 90094-2002 | 2017-04-19 |
| 1760876783 | Rmpm Group Inc | Podiatrist | 5450 Lincoln Blvd, Playa Vista, CA 90094-2002 | 2015-03-27 |
| 1649315508 | Casper Glenn | Personal Emergency Response Attendant | 5450 Lincoln Blvd, Playa Vista, CA 90094-2002 | 2007-02-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225408586 | Merle Morgan | Acupuncturist | 12871 W. Runway Rd, Unit 1, Playa Vista, CA 90094 | 2015-09-30 |
| 1134518004 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 12746 W Jefferson Blvd, Ste 3160, Playa Vista, CA 90094 | 2015-01-15 |
| 1619170537 | Ivette Osorio | Speech-Language Pathologist | 13080 Pacific Promenade, #213, Playa Vista, CA 90094 | 2007-06-07 |
| 1033201363 | Nancy Lee Rosser | Psychiatry & Neurology | 200 S. Barrington Ave., 1907, Los Angeles, CA 90094 | 2006-09-28 |
| 1134570476 | Mahsa Eghbali | Pharmacist | 12746 W Jefferson Blvd, Playa Vista, CA 90094 | 2016-06-28 |
| 1871960708 | Cassandra Wong | Nurse Practitioner | 12746 W Jefferson Blvd, Playa Vista, CA 90094 | 2015-08-26 |
| 1336505460 | West Coast Surgical Associates | Clinic/Center | 5450 Pacific Coast Hwy, 545, Playa Vista, CA 90094-2002 | 2016-01-05 |
| 1225308729 | Stephanie Cohen | Social Worker | 13175 Fountain Park Dr, A-420, Playa Vista, CA 90094-2023 | 2011-12-31 |
| 1598711566 | Playa Physical Therapy | Clinic/Center | 13163 Fountain Park Dr, Suite A, Playa Vista, CA 90094-2040 | 2006-05-25 |
| 1790035632 | Terry Chu | Physical Therapist | 13163 Fountain Park Dr, Suite A, Playa Vista, CA 90094-2040 | 2012-09-19 |
| Find all providers in zip 90094 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
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| 1396344321 | Sadeghi Medical Corporation | Surgery | 3871 Piedmont Ave # 105, Oakland, CA 94611-5378 | 2020-10-21 |
| 1295332823 | Vneo Medical Clinic Inc | Surgery | 6817 1/2 Kester Ave, Van Nuys, CA 91405-3716 | 2020-10-06 |
| 1619584497 | Prohealth Partners A Medical Group | Surgery | 3628 E Imperial Hwy Ste 303, Lynwood, CA 90262-2646 | 2020-09-25 |
| 1235744004 | Yvette Speight Md Inc | Surgery | 433 N Doheny Dr, Beverly Hills, CA 90210-5734 | 2020-09-09 |
| 1538786900 | Tdwo Inc | Surgery | 57445 29 Palms Hwy Ste 301, Yucca Valley, CA 92284-2947 | 2020-07-01 |
| 1003439746 | Howard Takiff | Surgery | 760 La Canada St, La Jolla, CA 92037-6724 | 2020-05-27 |
| 1629698253 | Gisela Regalado Paredes | Surgery | Antelope Valley Hospital, 1600 West Ave J, Lancaster, CA 93534 | 2020-04-23 |
| 1811517667 | John K Colwell | Surgery | 222 Hollywood Ave, Los Gatos, CA 95030 | 2020-04-22 |
| 1295361772 | William Robert Berry | Surgery | 5775 Del Cerro Blvd, San Diego, CA 92120-4513 | 2020-03-17 |
| 1497380638 | Bay Area Medical and Surgical Group, Inc. | Surgery | 490 Post St Ste 530, San Francisco, CA 94102-1412 | 2020-03-09 |
| Find all providers with the same taxonomy | ||||
| City | PLAYA VISTA |
| Zip Code | 90094 |
Please comment or provide details below to improve the information on PACIFIC MEDICAL GROUP.
| 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.