PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA (NPI# 1821019514) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821019514 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA |
| Other Organization Name | PROVIDENCE LITTLE COMPANY OF MARY MEDICAL CENTER SAN PEDRO |
| Practice Address |
1300 W 7th St San Pedro CA 90732-3505 |
| Mailing Address |
Po Box 2335 Spokane WA 99210-2335 |
| Practice Telephone | 3103037496 |
| Practice Fax Number | 3103037575 |
| Mailing Telephone | 3103037496 |
| Mailing Fax Number | 3103037575 |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2018-12-14 |
| Authorized Official Name | DONALD WAYNE ANDERSON JR. (DIRECTOR REIMBURSEMENT ADMIN) |
| Authorized Official Telephone | 4255255392 |
| Is Organization Subpart | Y |
| Parent Organization Name | PROVIDENCE HEALTH SYSTEM - SOUTHERN CALIFORNIA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 273Y00000X | Rehabilitation Unit | Hospital Units |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE CROSS | 05T078 | 01 |
| Other Name | Type Code |
|---|---|
| Providence Little Company of Mary Medical Center San Pedro | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497241541 | Providence Health System - Southern California | Community/Behavioral Health | 1386 W 7th St # A, San Pedro, CA 90732-3517 | 2018-07-02 |
| 1477647444 | Providence Health System - Southern California | Skilled Nursing Facility | 10425 Magnolia Blvd, North Hollywood, CA 91601-4109 | 2006-10-03 |
| 1770639809 | Providence Health System - Southern California | Skilled Nursing Facility | 1322 W 6th St, San Pedro, CA 90732-3501 | 2007-01-25 |
| 1700808383 | Providence Health System - Southern California | Skilled Nursing Facility | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-24 |
| 1902824758 | Providence Health System - Southern California | Rehabilitation Unit | 15031 Rinaldi St, Mission Hills, CA 91345-1207 | 2006-07-18 |
| 1669490819 | Providence Health System - Southern California | Rehabilitation Unit | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-17 |
| 1154349371 | Providence Health System - Southern California | Psychiatric Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-17 |
| 1750309837 | Providence Health System - Southern California | Skilled Nursing Facility | 11600 Indian Hills Rd, Building A, Mission Hills, CA 91345-1225 | 2006-07-17 |
| 1477587632 | Providence Health System - Southern California | General Acute Care Hospital | 15031 Rinaldi St, Mission Hills, CA 91345 | 2006-07-11 |
| 1336173269 | Providence Health System - Southern California | General Acute Care Hospital | 501 S Buena Vista St, Burbank, CA 91505-4809 | 2006-07-10 |
| Street Address |
1300 W 7TH ST |
| City | SAN PEDRO |
| State | CA |
| Zip Code | 90732-3505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356323828 | Jason C Kantor | Radiology | 1300 W 7th St, San Pedro, CA 90732-3505 | 2005-11-18 |
| 1598366486 | Nina Sabet-peyman, Md Inc. | Hospice, Inpatient | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-11-05 |
| 1154922185 | Melissa Louise Zankich-patalan | Nurse Practitioner | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-11-05 |
| 1063011104 | Christina Margarita Villasenor | Occupational Therapist | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-10-20 |
| 1073125480 | Peguy-emmanuelle Alva | Registered Nurse | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-08-18 |
| 1518588433 | Southern California Emergency Medical Group | Emergency Medicine | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-05-01 |
| 1033748744 | Jenna Nicole East | Speech-Language Pathologist | 1300 W 7th St, San Pedro, CA 90732-3505 | 2020-04-04 |
| 1023654555 | Susan Marie Smith | Registered Nurse | 1300 W 7th St, San Pedro, CA 90732-3505 | 2019-11-19 |
| 1477196269 | Vilma Asuma | Registered Nurse | 1300 W 7th St, San Pedro, CA 90732-3505 | 2019-10-24 |
| 1932742905 | Professional Anesthesia Associates PC | Nurse Anesthetist, Certified Registered | 1300 W 7th St, San Pedro, CA 90732-3505 | 2019-10-23 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538771241 | Alicia Avila | Student in an Organized Health Care Education/Training Program | 2227 Blue Butterfly Way, #7, San Pedro, CA 90732 | 2020-08-24 |
| 1619500543 | Udana Harris | Registered Nurse | 1300 West 7th Street, Obhc Unit, San Pedro, CA 90732 | 2020-02-19 |
| 1861042301 | Patricia Elaine Moses | Technician | 106 N. Western Ave Unit 102, San Pedro, CA 90732 | 2019-09-17 |
| 1629627393 | Antonio Ramon Martinez | Technician | 3141 Blue Butterfly Unit 66, San Pedro, CA 90732 | 2019-09-05 |
| 1487207700 | Victoria A. Shook, D.d.s., A Professional Corp. | Dentist | 28138 S. Western Ave., San Pedro, CA 90732 | 2019-07-17 |
| 1144566563 | Shaun E Chandran M D Inc | Orthopaedic Surgery | 1360 W 6th Street, Suite 305, San Pedro, CA 90732 | 2012-12-13 |
| 1316281280 | Jenny Luong | Physician Assistant | 1534 W. 25th St, San Pedro, CA 90732 | 2012-11-16 |
| 1033429519 | Eric M Feit Dpm Inc | Podiatrist | 1360 West 6th St., Suite 240, San Pedro, CA 90732 | 2010-10-18 |
| 1386808673 | Meysam Zaker | Dentist | 2470 S. Western Ave, San Pedro, Ca, CA 90732 | 2008-07-15 |
| 1376735340 | Francisco J. Correa, M.d., Inc | General Practice | 1350 W. 6th St, #3, San Pedro, CA 90732 | 2007-08-14 |
| Find all providers in zip 90732 | ||||
| Taxonomy Code | 273Y00000X |
| Grouping | Hospital Units |
| Classification | Rehabilitation Unit |
| In general, a distinct unit of a general acute care hospital that provides care encompassing a comprehensive array of restoration services for the disabled and all support services necessary to help patients attain their maximum functional capacity. Source: AHA Annual Survey p. A10 1996 AHA Guide. For Medicare, a distinct part of a general acute care hospital providing inpatient rehabilitation services that meets the following requirements. Rehabilitation Units have in effect a preadmission screening procedure under which each prospective patient’s condition and medical history are reviewed to determine whether the patient is likely to benefit significantly from an intensive inpatient program or assessment; ensure that the patients receive close medical supervision and furnish, through the use of qualified personnel, rehabilitation nursing, physical therapy and occupational therapy, plus, as needed, speech therapy, social services or psychological services and orthotic and prosthetic services; have a plan of treatment for each inpatient that is established, reviewed, and revised as needed by a physician in consultation with other professional personnel who provide services to the patient; use a coordinated multidisciplinary team approach in the rehabilitation of each inpatient, as documented by periodic clinical entries made in the patient’s medical record to note the patient's status in relationship to goal attainment, and that team conferences are held at least every two weeks to determine the appropriateness of treatment; have a director of rehabilitation who provides services to the unit and its inpatients for at least 20 hours a week, is a doctor of medicine or osteopathy, is licensed under State law to practice medicine or surgery, and has had, after completing a one-year hospital internship at least two years of training or experience in the medical management of inpatients requiring rehabilitation services. |
| Notes: Source: Code of Federal Regulations #42, Section 412.29. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831113802 | San Pedro Peninsula Hospital | Rehabilitation Unit | 1300 W 7th St, San Pedro, CA 90732-3505 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851909543 | Harmony Rehab PC | Rehabilitation Unit | 530 Showers Dr Ste 7-212, Mountain View, CA 94040-4740 | 2020-07-17 |
| 1659813012 | Jordan Leeann Isom | Rehabilitation Unit | 3322 Saint Omer St Apt 33, Cottonwood, CA 96022-9414 | 2016-11-15 |
| 1568911972 | Van Ngo | Rehabilitation Unit | 3939 Monroe Ave Apt 124, Fremont, CA 94536-6903 | 2016-09-26 |
| 1659756450 | Rehab Alliance | Rehabilitation Unit | 1720 Mt View Ave, Loma Linda, CA 92354-1727 | 2015-07-22 |
| 1265828966 | Therasens Occupational Therapy | Rehabilitation Unit | 1900 Garden Rd Ste 200c, Monterey, CA 93940-5373 | 2015-04-09 |
| 1396081394 | Quest Psychological Consulting, Inc. | Rehabilitation Unit | 18411 Gothard St Unit I, Huntington Beach, CA 92648-1208 | 2012-12-19 |
| 1477805877 | First Rehabilitation Specialists, Inc. | Rehabilitation Unit | 475 Hamilton St, San Francisco, CA 94134-1731 | 2012-10-09 |
| 1316298607 | Dynamic Therapy Group, Inc. | Rehabilitation Unit | 8100 Hansom Dr, Oakland, CA 94605-4211 | 2012-09-26 |
| 1184973752 | Providence Speech and Hearing Center | Rehabilitation Unit | 1301 Providence Ave., Orange, CA 92868 | 2012-08-29 |
| 1396003034 | Armour X Sports In Orthopedic Medicine | Rehabilitation Unit | 22482 Lake Forest Ln, Lake Forest, CA 92630-3024 | 2012-05-01 |
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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.