PRAIRIE MEDICAL GROUP (NPI# 1194846410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194846410 |
| Entity Type | Organization |
| Organization Name | PRAIRIE MEDICAL GROUP |
| Practice Address |
4644 Lincoln Blvd Suite 428 Marina Del Rey CA 90292 |
| Mailing Address |
Dept 2834 Los Angeles CA 90084 |
| Practice Telephone | 3102148677 |
| Practice Fax Number | 3109211718 |
| Mailing Telephone | 3103061888 |
| Mailing Fax Number | 3105778290 |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | CHRISTOPHER C CHIDI (PRESIDENT) |
| Authorized Official Telephone | 3102148677 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 058963 | CA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0078675 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538332960 | Prairie Medical Group | Internal Medicine | 8540 S Sepulveda Blvd, Los Angeles, CA 90045-3807 | 2008-04-07 |
| Street Address |
4644 LINCOLN BLVD SUITE 428 |
| City | MARINA DEL REY |
| State | CA |
| Zip Code | 90292 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972503431 | Anthony Joseph Zoppi | Orthopaedic Surgery | 4644 Lincoln Blvd, Ste #101, Marina Del Rey, CA 90292-6621 | 2005-07-27 |
| 1104295278 | Matthew James Cunningham | Physician Assistant | 4644 Lincoln Blvd, Marina Del Rey, CA 90292-6313 | 2015-09-18 |
| 1356778476 | Marina Dermatology Associates | Dermatology | 4644 Lincoln Blvd, Suite 552, Marina Del Rey, CA 90292-6313 | 2013-10-03 |
| 1639444714 | Grant Stevens, M.d., Inc | Plastic Surgery | 4644 Lincoln Blvd, Suite 552, Marina Del Rey, CA 90292-6391 | 2012-03-21 |
| 1033483193 | Jonathan D. Rand, M.d. Inc | Internal Medicine | 4644 Lincoln Blvd, 113, Marina Del Rey, CA 90292-6313 | 2012-03-06 |
| 1154692507 | Eleby R. Washington IIi Md PC | Orthopaedic Surgery | 4644 Lincoln Blvd, Suite 101, Marina Del Rey, CA 90292-6313 | 2012-01-17 |
| 1255609004 | Jeremy E. Korman Md, A Professional Corporation | Non-Pharmacy Dispensing Site | 4644 Lincoln Blvd, Suite 450, Marina Del Rey, CA 90292-6313 | 2011-12-08 |
| 1750683090 | Robert P. Waldman, M.d. A Professional Corporation | Internal Medicine | 4644 Lincoln Blvd, Ste 540, Marina Del Rey, CA 90292-6313 | 2010-11-18 |
| 1679886535 | Heleen Robins Md Inc | Family Medicine | 4644 Lincoln Blvd, Suite 408, Marina Del Rey, CA 90292-6313 | 2010-07-21 |
| 1295050714 | Akash Bajaj Md Inc A California Professional Medical Corporation | Pain Medicine | 4644 Lincoln Blvd, Suite 424, Marina Del Rey, CA 90292-6313 | 2010-03-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972142420 | Katy Kleinberg | Physical Therapist | 4820 Lincoln Blvd., Marina Del Rey, CA 90292 | 2020-01-02 |
| 1568028330 | Kylie Nakamine | Physical Therapist | 4820 Lincoln Bld, Marina Del Rey, CA 90292 | 2019-05-16 |
| 1033627807 | Kareema Nasouf | Social Worker | 578 Washington Blvd. #815, Marina Del Rey, CA 90292 | 2018-01-16 |
| 1861916611 | Jaqueline Berenice Higbee | Behavior Technician | 13428 Maxella Ave Apt 913, Marina Del Rey, CA 90292 | 2017-08-02 |
| 1063942696 | Luis Albert Japngie | Chiropractor | 13816 Bora Bora Way, A-109, Marina Del Rey, CA 90292 | 2017-06-15 |
| 1427509082 | Melissa Dowling | Nurse Anesthetist, Certified Registered | 4750 Lincoln Blvd Apt 477, Marina Del Rey, CA 90292 | 2016-10-19 |
| 1578932950 | Gratto Aquatic Rehab | Clinic/Center | 13160 Mindanao Way Ste. 308, Marina Del Ray, CA 90292 | 2015-09-16 |
| 1285018309 | Reed Chiropractic & Wellness Center A Professional Corporation | Chiropractor | 4207 Del Rey Ave., Marina Del Rey, CA 90292 | 2015-07-18 |
| 1083990725 | James J Kim | Pharmacist | 4009 Lincoln Blvd., Walgreens, Marina Del Rey, CA 90292 | 2011-10-26 |
| 1689957805 | Medbil, LLC | Anesthesiology | 1024 Oxford Ave., Marina Del Rey, CA 90292 | 2011-09-23 |
| Find all providers in zip 90292 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649713561 | Robert Strier | Specialist | 13603 Marina Pointe Dr Apt A601, Marina Del Rey, CA 90292-8573 | 2016-11-25 |
| 1689709008 | William Grant Stevens | Specialist | 4644 Lincoln Blvd Ste 552, Marina Del Rey, CA 90292-6391 | 2007-02-23 |
| 1568531945 | Ralph Bloch | Specialist | 4316 Marina City Dr, 931, Marina Del Rey, CA 90292-5832 | 2006-11-07 |
| 1417061714 | Daniel R Marcus | Specialist | 4640 Admiralty Way Ste 1020, Marina Del Rey, CA 90292-6641 | 2006-08-17 |
| 1487689329 | Robert Phlip Waldman | Specialist | 4644 Lincoln Blvd Ste 540, Marina Del Rey, CA 90292-6391 | 2006-07-11 |
| 1588653943 | Prostate Oncology Specialists, Inc. | Specialist | 4676 Admiralty Way, Ste 101, Marina Del Rey, CA 90292-6601 | 2005-10-18 |
| 1225382054 | Oband, Inc | Specialist | 4333 Admiralty Way, Marina Del Rey, CA 90292-5469 | 2012-10-31 |
| 1992942254 | Gary Brazina Md, Inc. | Specialist | 13160 Mindanao Way Ste 300, Marina Del Rey, CA 90292-6393 | 2009-01-08 |
| 1831334010 | Edgar Allan R Musngi, M.d. Inc. | Specialist | 4644 Lincoln Blvd Ste 540, Marina Del Rey, CA 90292-6391 | 2008-12-02 |
| 1932314408 | Watkins Spine, Inc. | Specialist | 4640 Admiralty Way, Suite 600, Marina Del Rey, CA 90292-6621 | 2007-05-10 |
| Find all providers in MARINA DEL REY | ||||
| City | MARINA DEL REY |
| Zip Code | 90292 |
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| 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.