Provider Demographics
NPI: | 1659312593 |
---|---|
Name: | HEALTHCARE PARTNERS AFFILIATES MEDICAL GROUP |
Entity Type: | Organization |
Organization Name: | HEALTHCARE PARTNERS AFFILIATES MEDICAL GROUP |
Other - Org Name: | OPTUM |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ADMINISTRATIVE ASSISTANT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | REBECCA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SCHAUMBURG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 310-525-3869 |
Mailing Address - Street 1: | P.O. BOX 6400 |
Mailing Address - Street 2: | |
Mailing Address - City: | TORRANCE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 90504-6400 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 310-525-3869 |
Mailing Address - Fax: | 310-783-5581 |
Practice Address - Street 1: | 1120 W WASHINGTON BLVD |
Practice Address - Street 2: | |
Practice Address - City: | LOS ANGELES |
Practice Address - State: | CA |
Practice Address - Zip Code: | 90015-3316 |
Practice Address - Country: | US |
Practice Address - Phone: | 213-623-2225 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-10 |
Last Update Date: | 2021-04-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
204C00000X, 207K00000X, 207L00000X, 207N00000X, 207Q00000X, 207QA0505X, 207R00000X, 207RC0000X, 207RE0101X, 207U00000X, 207VG0400X, 207VM0101X, 207W00000X, 207Y00000X | ||
CA | BU20504720 | 261QA1903X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207QA0505X | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | Group - Multi-Specialty |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Group - Multi-Specialty | |
No | 207VG0400X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology | Group - Multi-Specialty |
No | 207VM0101X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | Group - Multi-Specialty |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
1289020001 | Medicare NSC | ||
CA | DM185A | Medicare PIN | |
1289020003 | Medicare PIN | ||
CO | DM185A | Medicare PIN | |
CA | 1289020001 | Medicare NSC | |
CA | W13687V | Medicare PIN | |
CA | 1289020003 | Medicare PIN | |
CA | W13687F | Medicare PIN | |
CA | W13687G | Medicare PIN | |
CA | W13687R | Medicare PIN | |
CA | W13687S | Medicare PIN | |
CA | W13687V | Medicare PIN | |
1289020003 | Medicare PIN | ||
CA | W13687Y | Medicaid | |
CA | S051198A | Medicare PIN | |
CA | W13687E | Medicare PIN | |
CA | W13687Q | Medicare PIN | |
CA | W13687W | Medicare PIN | |
CA | W13687 | Medicare PIN | |
CA | W13687D | Medicaid | |
CA | 1289020001 | Medicare NSC | |
CA | W13687A | Medicare PIN | |
CA | W13687B | Medicare PIN | |
CA | W13687I | Medicare PIN | |
CA | W13687Z | Medicaid | |
CA | W13687K | Medicaid | |
CA | W13687M | Medicare PIN | |
CA | W13687N | Medicare PIN | |
CA | W13687T | Medicare PIN | |
CA | W13687X | Medicare PIN |