| Monument Telehealth Group | |
|
5800 S Eastern Ave Ste 500 Commerce CA 90040-4033 | |
| (646) 960-3553 | |
| Not Available |
| Full Name | Monument Telehealth Group |
|---|---|
| Speciality | Family Medicine |
| Location | 5800 S Eastern Ave Ste 500, Commerce, California |
| Authorized Official Name and Position | Julia Crouse (INSURANCE OPERATIONS MANAGER) |
| Authorized Official Contact | 6469603553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Monument Telehealth Group 5800 S Eastern Ave Ste 500 Commerce CA 90040-4033 Ph: () - | Monument Telehealth Group 5800 S Eastern Ave Ste 500 Commerce CA 90040-4033 Ph: (646) 960-3553 |
| NPI Number | 1194332510 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 05/31/2023 |
| Certification Date | 05/31/2023 |
| Medicare PECOS PAC ID | 2769898378 |
|---|---|
| Medicare Enrollment ID | O20210305001355 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194332510 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Secondary |
| 207QA0401X | Family Medicine - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Trevor Macdonough Agar |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326149279 PECOS PAC ID: 5395746945 Enrollment ID: I20070124000537 |
| Provider Name | Kevin P Feig |
|---|---|
| Provider Type | Practitioner - Preventive Medicine |
| Provider Identifiers | NPI Number: 1376566455 PECOS PAC ID: 6709882798 Enrollment ID: I20081111000226 |
| Provider Name | Deslin Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1679757124 PECOS PAC ID: 1355536988 Enrollment ID: I20101109001084 |
| Provider Name | Stephen Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548622699 PECOS PAC ID: 8325374176 Enrollment ID: I20190731002847 |
| Provider Name | David Crabtree |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881080638 PECOS PAC ID: 2668727439 Enrollment ID: I20200108002413 |
| Provider Name | Jiseung Yoon |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1144742420 PECOS PAC ID: 8325455041 Enrollment ID: I20210325000850 |
| Provider Name | Janice Nichols |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689980393 PECOS PAC ID: 1850417908 Enrollment ID: I20210329000907 |
| Provider Name | Leah Ghods |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1144538802 PECOS PAC ID: 8022425537 Enrollment ID: I20210330001368 |
| Provider Name | Huy Nguyen Ho |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962843268 PECOS PAC ID: 6103165030 Enrollment ID: I20210422000739 |
| Provider Name | Elizabeth Ellen Klenk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194042432 PECOS PAC ID: 6002005014 Enrollment ID: I20210426002608 |
| Provider Name | Anagha A Deshmukh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1265615496 PECOS PAC ID: 3476635970 Enrollment ID: I20210526001289 |
| Provider Name | Timothy Ibrahim |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1245737709 PECOS PAC ID: 7618376047 Enrollment ID: I20210604000518 |
| Provider Name | Rachelle Ann Reposa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164044574 PECOS PAC ID: 0840668745 Enrollment ID: I20221128001182 |
| Provider Name | Michael Lahey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922341825 PECOS PAC ID: 6507092392 Enrollment ID: I20221130003566 |
| Provider Name | Michael Buck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669631644 PECOS PAC ID: 5193194389 Enrollment ID: I20221209001971 |
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