| Pacific Palisades Medical Group Inc. | |
|
15200 W Sunset Blvd Suite 107 Pacific Palisades CA 90272-3619 | |
| (310) 459-7736 | |
| (310) 230-0284 |
| Full Name | Pacific Palisades Medical Group Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 15200 W Sunset Blvd, Pacific Palisades, California |
| Authorized Official Name and Position | Richard Johnson (PRESIDENT) |
| Authorized Official Contact | 3104597736 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Palisades Medical Group Inc. 15200 W Sunset Blvd Suite 107 Pacific Palisades CA 90272-3619 Ph: (310) 459-7736 | Pacific Palisades Medical Group Inc. 15200 W Sunset Blvd Suite 107 Pacific Palisades CA 90272-3619 Ph: (310) 459-7736 |
| NPI Number | 1215037049 |
|---|---|
| Provider Enumeration Date | 09/22/2006 |
| Last Update Date | 05/14/2021 |
| Medicare PECOS PAC ID | 1153393517 |
|---|---|
| Medicare Enrollment ID | O20040806001220 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215037049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Krystyna E Mcnicoll |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750392247 PECOS PAC ID: 7416929872 Enrollment ID: I20040807000231 |
| Provider Name | Gary A Green |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154345254 PECOS PAC ID: 8325010788 Enrollment ID: I20040807000241 |
| Provider Name | Richard A Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770596009 PECOS PAC ID: 4789656141 Enrollment ID: I20040807000247 |
| Provider Name | Julie M Ma |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1306865688 PECOS PAC ID: 6507838968 Enrollment ID: I20040807000259 |
| Provider Name | Ericka M Gair |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376660704 PECOS PAC ID: 8325221401 Enrollment ID: I20110328000343 |
Uc Regents Ucla Dept Of Medicine Prof Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 15200 W Sunset Blvd, Pacific Palisades, CA 90272 Phone: 310-230-0284 | |
Na Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 16820 Edgar St, Pacific Palisades, CA 90272 Phone: 310-459-2597 Fax: 310-268-4086 | |
Damon B. Raskin Md Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 881 Alma Real Dr, Suite 103, Pacific Palisades, CA 90272 Phone: 310-459-4333 Fax: 310-454-4707 | |
Lori A Musto, Do Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 881 Alma Real Dr Ste 110, Pacific Palisades, CA 90272 Phone: 310-454-1212 | |
Michael R Block M D Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 970 Monument St, Suite 210, Pacific Palisades, CA 90272 Phone: 310-459-4321 Fax: 310-459-5326 | |
Robert M Kahn Md Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 881 Alma Real Dr, Suite 103, Pacific Palisades, CA 90272 Phone: 310-459-4333 Fax: 310-454-4707 |