Provider Demographics
NPI:1629037577
Name:APPLECARE HOSPITALIST MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:APPLECARE HOSPITALIST MEDICAL GROUP, INC.
Other - Org Name:OPTUM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-869-1070
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90702-1088
Mailing Address - Country:US
Mailing Address - Phone:562-869-1070
Mailing Address - Fax:562-286-8777
Practice Address - Street 1:11525 BROOKSHIRE AVE STE 300
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4982
Practice Address - Country:US
Practice Address - Phone:562-869-4497
Practice Address - Fax:562-869-6317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTUM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-20
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3035207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095550Medicaid
CAGR0095550Medicaid