Look up the most recent NPI and PECOS records

Rephana Medical Group

Internal Medicine

Allopathic & Osteopathic Physicians

1304 15th St Ste 402, Santa Monica, CA 90404-1813

PECOS Enrollment

Based on the most recent information from CMS, provider Rephana Medical Group does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1659414258
Provider Type
Organization
Full Name
Rephana Medical Group

Subpart
No
Enumeration Date
2/14/2007
Last Updated
8/22/2020

Contact Information

Practice Location

1304 15th St Ste 402, Santa Monica, CA 90404-1813

(310) 451-0111

Unlisted Fax

Mailing Location

5850 W 3rd St # 132, Los Angeles, CA 90036-2860

(310) 451-0111

Unlisted Fax

Authorized Official

Shanblatt, Neal (President)

(310) 451-0111

Provider Taxonomies

Code	Description	License
Code 207R00000X Primary	Description Internal Medicine Allopathic & Osteopathic Physicians	License A64647 California

Provider Identifiers

ID	Description	Issuer
ID 00A646470	Description Medicaid	Issuer Unlisted California

Rephana Medical Group

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Ahmed, Rafi Syed

Hua, Johnson

Stepanyan, Katelyn Dow

Garvey, Sarah Lauren

Mcgowan, Mark Scheer

Westside Primary Care, Inc.

Suraweera, Ashley

Olvera, Vanessa Denyse

Simpler, Laura Diane

Ji, Jingran