EMERGENCY DEPARTMENT PHYSICIANS MEDICAL GROUP, INC. (NPI# 1730104498) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730104498 |
| Entity Type | Organization |
| Organization Name | EMERGENCY DEPARTMENT PHYSICIANS MEDICAL GROUP, INC. |
| Practice Address |
1225 Wilshire Boulevard Los Angeles CA 90017-2395 |
| Mailing Address |
2550 North Hollywood Way Suite 209 Burbank CA 91505-5015 |
| Practice Telephone | 2134822741 |
| Mailing Telephone | 8185570135 |
| Mailing Fax Number | 8185571394 |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-10-10 |
| Authorized Official Name | DR. PHILIP J FAGAN (PRESIDENT) |
| Authorized Official Telephone | 8185570135 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GOOD SAM BLUE SHIELD | ZZZ42800Z | 01 |
| CA | GR0014357 | 05 | |
| CA | GOOD SAM RAILROAD | CC6638 | 01 |
| Street Address |
1225 WILSHIRE BOULEVARD |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90017-2395 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376596668 | Jack G. Fuller | Physician Assistant | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-18 |
| 1316122104 | Sung Im | Anesthesiology | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2007-12-31 |
| 1952477499 | Robert A Kloner | Specialist | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-11-27 |
| 1588689236 | Fagan Er Medical Group Inc | Internal Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-07-13 |
| 1922049295 | Melvin L Jackson | Emergency Medicine | 1225 Wilshire Boulevard, Good Samaritan Hospital, Los Angeles, CA 90017-2395 | 2006-06-09 |
| 1427004621 | Ronald E. Lieberman | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-26 |
| 1114972726 | Kristina L. Stilwell | Physician Assistant | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-23 |
| 1144274168 | Robert F. Kerns | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-22 |
| 1457305344 | Nancy J. Kuhn | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-22 |
| 1164476883 | John A. Hatherley | Emergency Medicine | 1225 Wilshire Boulevard, Los Angeles, CA 90017-2395 | 2006-05-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144833617 | Guadalupe Vallejo | Licensed Vocational Nurse | 515 Columbia Avenue, #200, 515 Columbia Avenue, Los Angeles, CA 90017 | 2020-08-25 |
| 1376181768 | Nirlok Corporation | Optometrist | 750 West 7th Street, Los Angeles, CA 90017 | 2019-12-16 |
| 1689228223 | Marycarmen Beltran | Student in an Organized Health Care Education/Training Program | 333 S. Beaudry Ave., Los Angeles, CA 90017 | 2019-08-01 |
| 1639661465 | Robin B Horowitz | Counselor | 333 South Beaudry Avenue, Los Angeles, CA 90017 | 2018-06-06 |
| 1710483797 | Rose Jadidian | Pharmacist | 701 S. Flower, Ste. 3150, Los Angeles, CA 90017 | 2018-03-30 |
| 1417469875 | Marykarla Gallegos | Case Manager/Care Coordinator | 1125 W. 6th St., Suite 103, Los Angeles, CA 90017 | 2017-10-25 |
| 1134646516 | Maria Salas | Rehabilitation Practitioner | 333 S Beaudry Ave., Los Angeles, CA 90017 | 2017-08-25 |
| 1932638202 | Butterfli Technologies Inc | Transportation Broker | 865 S Figueroa St Ste 2750, Los Angeles, CA 90017 | 2017-06-08 |
| 1316493125 | Phamily Love Foundation | Community/Behavioral Health | 626 Wilshire Blvd ., Suite 910, Los Angeles, CA 90017 | 2016-08-31 |
| 1215392188 | Jessica R. Garcia-hillard | Specialist/Technologist | 1111 W. 6th St., Suite 111, Los Angeles, CA 90017 | 2015-12-21 |
| Find all providers in zip 90017 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558717983 | James Marvel | Emergency Medicine | 1520 Rodney Dr Apt 411, Los Angeles, CA 90027-5327 | 2016-05-04 |
| 1871956359 | Gregory Elbert Tong | Emergency Medicine | 942 Westwood Boulevard, Suite 300, Los Angeles, CA 90024 | 2016-04-01 |
| 1073979704 | Erik Akopian | Emergency Medicine | 1200 N State St Ste Ct-a7d, Los Angeles, CA 90033-1029 | 2016-01-11 |
| 1043685969 | Abraham Flinders | Emergency Medicine | 1021 N Bonnie Brae St, Los Angeles, CA 90026-3110 | 2015-12-03 |
| 1164892501 | Benjamin Musser | Emergency Medicine | 1957 Preston Ave, Los Angeles, CA 90026-1827 | 2015-09-28 |
| 1295138022 | Brian Raffetto | Emergency Medicine | 1200 N State St Rm A7d, Los Angeles, CA 90033-1029 | 2014-10-07 |
| 1427450691 | Ariel Justine Bowman | Emergency Medicine | 1200 N. State Street, Ct-room A7d, Los Angeles, CA 90033 | 2014-09-19 |
| 1093150476 | Sushil Jain | Emergency Medicine | 6041 Cadillac Ave Dept Of, Los Angeles, CA 90034-1702 | 2013-04-30 |
| 1497198402 | Russell Andrew Johnson | Emergency Medicine | 100 Ucla Medical Plaza Suite 490, Los Angeles, CA 90095-1103 | 2013-04-09 |
| 1114260858 | Catherine Marie Weaver | Emergency Medicine | 757 Westwood Plz Ste 1517, Los Angeles, CA 90095-8358 | 2013-04-01 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90017 |
Please comment or provide details below to improve the information on EMERGENCY DEPARTMENT PHYSICIANS MEDICAL GROUP, INC..
| 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.