Table family_pact_providers_profile_cy

Table: family_pact_providers_profile_cy_2019 , provider_business_legal_name like B*

A B C D E F G H I J K L M N O P Q R S T U V W X Y Z *

provider_number	npi_provider_number	owner_number	service_location_number	provider_business_legal_name	enrollment_status_effective_date	provider_type_code	provider_type_code_desc	provider_license_number	provider_specialty_code	provider_specialty_code_desc	out_of_state_ind_desc	provider_address_county_code	provider_address_county_code_description	attention_line	provider_address_line1	provider_address_line2	provider_address_city	provider_address_state	provider_address_zip	provider_address_latitude	provider_address_longitude	mssa_id	tract_id
1003824020	1003824020	1	1	BAYLON, PAUL M MD	19-Sep-05	Physicians (026)	PHYSICIANS	G00048547	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	19	Los Angeles	None	3118-3120 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	33.972891	-118.212379	78.2ccc	5332.03
1003867565	1003867565	1	1	BARTON MEMORIAL HOSPITAL	26-Jan-99	Community Hosp Outpatient (015)	COMMUNITY OUTPATIENT HOSPITAL	90300793	99	Unknown (on EDS claims)	In state provider	9	El Dorado	None	2170 SOUTH AVE	None	S LAKE TAHOE	CA	96150	38.912336	-119.998043	24	304.02
1003902610	1003902610	1	1	BRISTOL-MCFADDEN MED GRP	13-Mar-97	Physicians Group (022)	PHYSICIANS GROUP	None	1	General Practice	In state provider	30	Orange	INC	1212 S BRISTOL ST	STE 16	SANTA ANA	CA	92704	33.732396	-117.885194	116g	747.02
1043392962	1043392962	1	1	BANSAL, JAGAN N MD INC	15-Aug-05	Physicians Group (022)	PHYSICIANS GROUP	A00034128	29	Pulmonary Diseases (M.D. only)	In state provider	19	Los Angeles	None	5540 N FIGUEROA ST	None	LOS ANGELES	CA	90042	34.108531	-118.194949	78.2i	1838.1
1053310326	1053310326	1	1	BARTON COMMUNITY HEALTH CTR	2-Mar-04	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	9	El Dorado	None	2201 SOUTH AVE	None	SOUTH LAKE TAHOE	CA	96150	38.912339	-119.996603	24	304.02
1053386565	1053386565	1	1	BETRE, ABRAHAM DO	5-Jan-09	Physicians (026)	PHYSICIANS	20A10290	9	Gynecology (D.O. only)	In state provider	54	Tulare	None	925 MERRITT AVE	None	TULARE	CA	93274	36.222009	-119.334354	230	23.03
1053691337	1053691337	1	1	BE, VIET A MD INC	6-Jun-01	Physicians (026)	PHYSICIANS	G00048753	1	General Practice	In state provider	30	Orange	None	11160 WARNER AVENUE	SUITE 301	FOUNTAIN VALLEY	CA	92708	33.716327	-117.934948	116j	992.26
1073619060	1073619060	1	1	BIG VALLEY OB-GYN MEDICAL	29-Nov-05	Physicians (026)	PHYSICIANS	20A5298	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	39	San Joaquin	CENTER INC	420 W ACACIA ST	STE 11	STOCKTON	CA	95203	37.961437	-121.29923	169b	4.01
1083735203	1083735203	1	1	BATRES, ERIC R MD	25-Sep-08	Physicians (026)	PHYSICIANS	G00044726	8	Family Practice	In state provider	19	Los Angeles	MEDICAL CORP	5101 FLORENCE AVE	STE 4	BELL	CA	90201	33.969061	-118.176068	78.2ddd	5338.05
1093226243	1093226243	1	1	BLOOMINGTON COMMUNITY HEALTH	21-Feb-19	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	36	San Bernardino	None	18651 VALLEY BLVD	None	BLOOMINGTON	CA	92316	34.070447	-117.397334	151f	36.06
1093969115	1093969115	1	6	BELL HIGH SCHOOL	12-Aug-19	Community Clinics (041)	COMMUNITY CLINIC	None	99	Unknown (on EDS claims)	In state provider	19	Los Angeles	INTERMITTENT	4328 BELL AVE	None	BELL	CA	90201	33.974739	-118.19033	78.2ddd	5336.02
1134144165	1134144165	1	1	BORREGO MEDICAL CLINIC	1-Nov-06	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	37	San Diego	FOUNDATION	4343 YAQUI PASS RD	None	BORREGO SPRINGS	CA	92004	33.193148	-116.330451	152	210
1154730828	1154730828	1	1	BALDWIN PARK COMMUNITY	10-Feb-15	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	19	Los Angeles	None	3942 MAINE AVE	None	BALDWIN PARK	CA	91706	34.084525	-117.961854	78.2zzz	4052.02
1184833501	1184833501	1	1	BELL GARDEN FAMILY	15-Aug-03	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	19	Los Angeles	None	6501 GARFIELD AVE	None	BELL GARDENS	CA	90201	33.972803	-118.147588	78.2c	5339.02
1184909103	1184909103	1	1	BROOKWOOD HEALTH CENTER	4-Jan-12	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	49	Sonoma	CENTERS	983 SONOMA AVENUE	STE A	SANTA ROSA	CA	95404	38.440546	-122.702144	210.1	1520
1184949455	1184949455	1	1	BARAJAS, RAYMOND A INC	29-Apr-97	Physicians (026)	PHYSICIANS	G00075499	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	19	Los Angeles	None	3560 SANTA ANITA AVE	STE H	EL MONTE	CA	91731	34.073922	-118.041692	78.2oo	4327
1205222544	1205222544	1	1	BAKER STREET VILLAGE COMMUNI	11-Oct-17	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	15	Kern	None	1015 BAKER STREET	SUITE 4	BAKERSFIELD	CA	93305	35.378997	-118.992215	66b	13
1245301308	1245301308	1	1	BURNEY HEALTH CENTER	1-Oct-02	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	45	Shasta	BURNEY HEALTH CENTER	37491 ENTERPRISE DR	None	BURNEY	CA	96013	40.887165	-121.647469	190	127.01
1265572903	1265572903	1	1	BROOKDALE MEDICA CENTER	11-Aug-06	Physicians Group (022)	PHYSICIANS GROUP	None	1	General Practice	In state provider	19	Los Angeles	INC	2809 TWEEDY BLVD	None	SOUTH GATE	CA	90280	33.945986	-118.221942	78.2ccc	5356.06
1275644098	1275644098	1	1	BANEZ, EDGAR MD	15-Sep-98	Physicians (026)	PHYSICIANS	A52430	1	General Practice	In state provider	19	Los Angeles	None	4867 EAGLE ROCK BLVD	SUITE 115	LOS ANGELES	CA	91405	34.199389	-118.448721	78.2cc	1279.1
1275656761	1275656761	1	1	BIR, RAGHBIR S MD	5-Nov-98	Physicians Group (022)	PHYSICIANS GROUP	A00042345	41	Internal Medicine	In state provider	36	San Bernardino	None	280 N RIVERSIDE AVE	None	RIALTO	CA	92376	34.10391	-117.370486	151h	37
1346492055	1346492055	1	1	BESHAY, ISSAC N MD	5-Jan-09	Physicians (026)	PHYSICIANS	A00089039	8	Family Practice	In state provider	30	Orange	None	2200 HARBOR BLVD	STE B 210	COSTA MESA	CA	92627	33.654345	-117.919091	116p	639.06
1376843771	1376843771	1	1	BRISTOL-MCFADDEN MEDICAL	15-Feb-11	Physicians Group (022)	PHYSICIANS GROUP	None	1	General Practice	In state provider	30	Orange	GROUP INC	1226 E MCFADDEN AVE	None	SANTA ANA	CA	92705	33.733603	-117.855114	116g	744.03
1467590901	1467590901	1	1	BEACH CITIES MIDWIFERY	21-May-01	Certified Nurse Midwife (005)	CERTIFIED NURSE MIDWIFE	None	99	Unknown (on EDS claims)	In state provider	30	Orange	& WOMEN'S HEALTH CARE	23141 MOULTON PKWY	108	LAGUNA HILLS	CA	92653	33.626416	-117.730569	115.2d	626.21
1487706347	1487706347	1	1	BLOOMINGTON COMMUNITY HEALTH	26-Aug-97	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	36	San Bernardino	INC	18601 VALLEY BLVD	None	BLOOMINGTON	CA	92316	34.070443	-117.39832	151f	36.06
1508109794	1508109794	1	1	BALTAIAN, LILIT MD INC	18-Feb-14	Physicians (026)	PHYSICIANS	A00105197	1	General Practice	In state provider	19	Los Angeles	None	7412 FOOTHILL BLVD	None	TUJUNGA	CA	91042	34.251551	-118.293456	78.2rr	1012.1
1518963693	1518963693	1	1	BERKELEY PRIMARY CARE	1-Mar-97	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	1	Alameda	BERKELEY PRIMARY CARE	2001 DWIGHT WAY	None	BERKELEY	CA	94704	37.863641	-122.269858	2a	4235
1518996313	1518996313	1	1	BEHROOZ YAGOOBIAN, MD	8-Jul-97	Physicians Group (022)	PHYSICIANS GROUP	FNP023072	42	Nuclear Medicine	In state provider	19	Los Angeles	LATINO MEDICAL CENTER	15730 PARAMOUNT BLVD	None	PARAMOUNT	CA	90723	33.889872	-118.160002	78.2m	5539.01
1528345915	1528345915	1	1	BALDWIN PARK MEDICAL CENTER	22-Dec-14	Physicians (026)	PHYSICIANS	20A7473	1	General Practice	In state provider	19	Los Angeles	INC	14362 E RAMONA BLVD	None	BALDWIN PARK	CA	91706	34.086349	-117.960992	78.2zzz	4052.02
1528433588	1528433588	1	1	BENTLEY HEALTH CENTER	1-Aug-17	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	50	Stanislaus	None	12619 BENTLEY ST	None	WATERFORD	CA	95386	37.640669	-120.761329	214	28.01
1548659105	1548659105	1	1	BEHAVIORAL HEALTH SERVICES	4-Sep-17	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	19	Los Angeles	INC	2501 W EL SEGUNDO BLVD	SUITE B	HAWTHORNE	CA	90250	33.916464	-118.320423	78.2bbbb	6026
1548795453	1548795453	1	1	BARSTOW COMMUNITY HEALTH CEN	28-Mar-19	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	36	San Bernardino	FOUNDATION	750 E MAIN ST	None	BARSTOW	CA	92311	34.89879	-117.015867	149	94
1568585024	1568585024	1	1	BIR, RAGHBIR S MD	16-Aug-02	Physicians Group (022)	PHYSICIANS GROUP	None	1	General Practice	In state provider	36	San Bernardino	None	9792 SIERRA AVE	None	FONTANA	CA	92335	34.075913	-117.435763	151f	33.01
1568800100	1568800100	1	1	BEST START MIDWIFE SERVICES	19-May-16	Certified Nurse Midwife (005)	CERTIFIED NURSE MIDWIFE	None	99	Unknown (on EDS claims)	In state provider	37	San Diego	None	3630 ENTERPRISE STREET	None	SAN DIEGO	CA	92110	32.746298	-117.198357	161b	65
1578708285	1578708285	1	1	BIGGS GRIDLEY HOSP	13-Oct-98	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	4	Butte	FAMILY CARE CTR	240 SPRUCE ST	None	GRIDLEY	CA	95948	39.366966	-121.690577	9	35.02
1578823647	1578823647	1	1	BANNING FAMILY COMMUNITY HEA	1-Dec-15	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	33	Riverside	SERVICES INC	1070 E RAMSEY STREET	None	BANNING	CA	92220	33.925352	-116.864988	134	442
1598936254	1598936254	1	1	BUTTONWILLOW HEALTH CTR	1-Mar-97	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	15	Kern	PO BOX 917	277 E FRONT ST	None	BUTTONWILLOW	CA	93206	35.39969	-119.466007	59	37
1629192133	1629192133	1	1	BEVERLY, SHEREEN L MD	25-Mar-05	Physicians (026)	PHYSICIANS	G00068251	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	19	Los Angeles	INC	16812 HAWTHORNE BLVD	None	LAWNDALE	CA	90260	33.87838	-118.352348	78.2iiii	6041
1669547618	1669547618	1	1	BARARSANI, MOHAMMAD MD	17-Sep-13	Physicians (026)	PHYSICIANS	A35392	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	19	Los Angeles	None	18051 CRENSHAW BLVD	SUITE #C	TORRANCE	CA	90504	33.866761	-118.326468	78.2iiii	6501.02
1669940003	1669940003	1	1	BUENA MEDICAL CLINIC	18-Apr-19	Physicians (026)	PHYSICIANS	None	8	Family Practice	In state provider	56	Ventura	None	631 COOPER RD	None	OXNARD	CA	93030	34.204553	-119.172425	241b	32.01
1699767517	1699767517	2	1	BELL PLAZA MEDICAL CLINIC	13-May-13	Physicians Group (022)	PHYSICIANS GROUP	None	1	General Practice	In state provider	19	Los Angeles	CORPORATION	4827 GAGE AVENUE	None	BELL	CA	90201	33.977217	-118.179412	78.2ddd	5338.04
1710261284	1710261284	1	1	BELLA MEDICAL GROUP INC	26-Mar-12	Physicians Group (022)	PHYSICIANS GROUP	None	99	Unknown (on EDS claims)	In state provider	19	Los Angeles	None	2933 WHITTIER BLVD	None	LOS ANGELES	CA	90023	34.030985	-118.208139	78.2h	2047
1740524552	1740524552	1	1	BARDOWELL, RICHARD MD INC	1-Jan-13	Physicians (026)	PHYSICIANS	A00041037	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	19	Los Angeles	None	2701 W ALAMEDA AVE	STE 303	BURBANK	CA	91505	34.157535	-118.330146	78.2ttt	3116
1750728663	1750728663	1	1	BALDWIN PARK FAMILY CLINIC	29-Apr-14	Physicians (026)	PHYSICIANS	G62452	1	General Practice	In state provider	19	Los Angeles	INC	14135 FRANCISQUITO AVE	STE 106	BALDWIN PARK	CA	91706	34.064032	-117.967911	78.2zzz	4048.03
1760936884	1760936884	1	1	BEVERLYCARE	12-Feb-19	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	19	Los Angeles	None	101 E BEVERLY BLVD	SUITE 303	MONTEBELLO	CA	90640	34.015664	-118.098592	78.2nn	5300.04
1780958462	1780958462	1	1	BAHARI MEDICAL GROUP	1-Feb-16	Physicians (026)	PHYSICIANS	20A7938	1	General Practice	In state provider	19	Los Angeles	PROFESSIONAL MEDICAL C	20829 VENTURA BLVD	None	WOODLAND HILLS	CA	91364	34.166363	-118.586542	78.2yy	1375.01
1811279763	1811279763	1	1	BARTZ ALTADONNA COMMUNITY	1-Jun-12	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	19	Los Angeles	HEALTH CENTER	43322 GINGHAM AVE	SUITE 104 & 105	LANCASTER	CA	93535	34.671365	-118.122268	77.1c	9005.04
1841419793	1841419793	1	1	BLACK, ROBIN	5-Jun-07	Certified Pediatric/Family NP (007)	CERTIFIED NURSE PRACTIONER	RN0268672	99	Unknown (on EDS claims)	In state provider	30	Orange	None	2077 HARBOR BLVD	STE C	COSTA MESA	CA	92627	33.649959	-117.919049	116p	637.02
1851577662	1851577662	1	1	BEACH AREA FAM HLTH CNTR	6-Jan-97	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	37	San Diego	SAN DIEGO INC	3705 MISSION BLVD	None	SAN DIEGO	CA	92109	32.782645	-117.25244	161a	76
1861680712	1861680712	1	1	BIENESTAR MEDICAL CENTER	8-Sep-09	Physicians Group (022)	PHYSICIANS GROUP	FNP030110	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	30	Orange	INC	1125 E 17TH STREET	SUITE N 152	SANTA ANA	CA	92701	33.759883	-117.854493	116h	754.03
1891862553	1891862553	1	1	BASELINE MEDICAL CLINIC INC	3-Oct-97	Physicians Group (022)	PHYSICIANS GROUP	None	1	General Practice	In state provider	36	San Bernardino	None	330 N D ST	STE 300	SAN BERNARDINO	CA	92401	34.105201	-117.291884	151g	57.01
1902944796	1902944796	1	1	BERKELEY PUBLIC HLTH CLINIC	15-Jun-10	Exempt from Licensure Clinics (045)	CLINIC EXEMP FROM LICENSURE	None	99	Unknown (on EDS claims)	In state provider	1	Alameda	COMP FAMILY PLANNING PRO	830 UNIVERSITY AVE	None	BERKELEY	CA	94710	37.867938	-122.297686	2a	4232
1912116385	1912116385	1	1	BAKERSFIELD HLTH SRVCS	16-Oct-07	Exempt from Licensure Clinics (045)	CLINIC EXEMP FROM LICENSURE	CLF3083	99	Unknown (on EDS claims)	In state provider	15	Kern	BAKERSFIELD HLTH SRVCS	9001 STOCKDALE HWY	# 28HC	BAKERSFIELD	CA	93311	35.354328	-119.103271	66d	28.06
1912928540	1912928540	1	1	BERNARDITA DE LOS REYES	24-Apr-01	Physicians Group (022)	PHYSICIANS GROUP	FNP015026	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	19	Los Angeles	CLINICA SANTA ISABEL MED	2760 E FLORENCE AVE	None	HUNTINGTON PARK	CA	90255	33.973776	-118.220823	78.2ccc	5331.07
1922124866	1922124866	1	2	BAYCHILDREN'S PHYSICIANS	8-Oct-18	Physicians Group (022)	PHYSICIANS GROUP	None	40	Pediatrics, Periodontist (Dentists Only)	In state provider	1	Alameda	None	1555 DOOLITTLE DRIVE	None	SAN LEANDRO	CA	94577	37.71189	-122.184754	2g	4324
1932115375	1932115375	1	1	BELLFLOWER HEALTH CENTER	28-Apr-97	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	19	Los Angeles	BELLFLOWER FAM PLANNING	10005 E FLOWER AVE	None	BELLFLOWER	CA	90706	33.882105	-118.120765	78.2m	5542.03
1932225208	1932225208	1	1	BADYMOGHADDAM, YAGHOUB	21-Apr-06	Physicians (026)	PHYSICIANS	A00052570	1	General Practice	In state provider	19	Los Angeles	None	5726 E OLYMPIC BLVD	None	LOS ANGELES	CA	90022	34.013977	-118.147502	78.2c	5323.03
1942638978	1942638978	1	1	BRIGHTER BEGINNINGS FAMILY	1-Dec-15	Health Access Program (058)	HEALTH ACCESS PROGRAM	550002684	99	Unknown (on EDS claims)	In state provider	7	Contra Costa	None	2727 MACDONALD AVE	None	RICHMOND	CA	94804	37.935033	-122.342699	18f	3740
1962538967	1962538967	1	1	BALBOA TEEN CLINIC	1-Mar-97	Health Access Program (058)	HEALTH ACCESS PROGRAM	None	99	Unknown (on EDS claims)	In state provider	38	San Francisco	None	1000 CAYUGA AVE	None	SAN FRANCISCO	CA	94112	37.722083	-122.439807	162d	261
1962644138	1962644138	1	1	BUI, FRANCOIS P MD INC	1-Sep-10	Physicians (026)	PHYSICIANS	A106596	16	Obstetrics-Gynecology (M.D. Only) Neonatal	In state provider	30	Orange	None	9741 BOLSA AVE	STE 119	WESTMINSTER	CA	92683	33.744915	-117.959345	116i	889.04
1992732192	1992732192	1	1	BOLSA MEDICAL GROUP	18-Mar-97	Physicians Group (022)	PHYSICIANS GROUP	FNP021388	1	General Practice	In state provider	30	Orange	None	10362 BOLSA AVE	STE 110	WESTMINSTER	CA	92683	33.744983	-117.948356	116i	889.04