NPI |
1912362252 |
The country code in the location address of the provider being identified. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Organization Name Legal Business Name |
GINGER.IO OF CALIFORNIA MEDICAL PC |
The date that a record was last updated or changed. |
Provider First Line Business Practice Location Address |
2415 MICHIGAN AVE |
The code designating the provider’s gender if the provider is a person. |
Provider Business Practice Location Address City Name |
SANTA MONICA |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider Business Practice Location Address State Name |
CA |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider Business Practice Location Address Postal Code |
904044009 |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Provider Business Practice Location Address Country Code If outside U S |
US |
|
Provider Business Practice Location Address Telephone Number |
8554463747 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Provider Business Practice Location Address Fax Number |
4158910725 |
|
Provider Enumeration Date |
12/30/2015 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
1/19/2023 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
CROMER |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
DAVIS |
The first name of the authorized official. |
Authorized Official Title or Position |
CLINICAL OPERATIONS MANAGER |
The title or position of the authorized official. |
Authorized Official Telephone Number |
8554464374 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
261QM0850X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
NPI Certification Date |
1/19/2023 |
|