Provider Demographics
NPI:1891981502
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:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHAUMBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-525-3869
Mailing Address - Street 1:PO BOX 6400
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-0400
Mailing Address - Country:US
Mailing Address - Phone:310-525-3869
Mailing Address - Fax:310-783-5581
Practice Address - Street 1:14591 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-6001
Practice Address - Country:US
Practice Address - Phone:714-442-4864
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13687VMedicare PIN
CAW13687DMedicare PIN
CAW13687YMedicare PIN
CAW13687KMedicare PIN
CAW13687ZMedicare UPIN