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
StateLicense IDTaxonomies
204C00000X, 207K00000X, 207L00000X, 207N00000X, 207Q00000X, 207QA0505X, 207R00000X, 207RC0000X, 207RE0101X, 207U00000X, 207VG0400X, 207VM0101X, 207W00000X, 207Y00000X
CABU20504720261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207U00000XAllopathic & Osteopathic PhysiciansNuclear MedicineGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1289020001Medicare NSC
CADM185AMedicare PIN
1289020003Medicare PIN
CODM185AMedicare PIN
CA1289020001Medicare NSC
CAW13687VMedicare PIN
CA1289020003Medicare PIN
CAW13687FMedicare PIN
CAW13687GMedicare PIN
CAW13687RMedicare PIN
CAW13687SMedicare PIN
CAW13687VMedicare PIN
1289020003Medicare PIN
CAW13687YMedicaid
CAS051198AMedicare PIN
CAW13687EMedicare PIN
CAW13687QMedicare PIN
CAW13687WMedicare PIN
CAW13687Medicare PIN
CAW13687DMedicaid
CA1289020001Medicare NSC
CAW13687AMedicare PIN
CAW13687BMedicare PIN
CAW13687IMedicare PIN
CAW13687ZMedicaid
CAW13687KMedicaid
CAW13687MMedicare PIN
CAW13687NMedicare PIN
CAW13687TMedicare PIN
CAW13687XMedicare PIN