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General NPI Number Information
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NPI Number | 1760949044
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Entity Type | Organization
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Legal Business Name | CHRONIC CARE MANAGEMENT GROUP INC
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/28/2020
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Provider Practice Location Address
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Address Line | 3756 SANTA ROSALIA DR STE 505
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City | LOS ANGELES
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State | CA
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Zip | 90008-3656
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Country | US
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Telephone | 323-903-5452
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HOLLAND STE 101
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City | IRVINE
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State | CA
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Zip | 92618-2568
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Country | US
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Telephone | 949-588-2190
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Fax | 949-588-2199
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Authorized Official
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Title or Position | PRESIDENT
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Name | BROWNELL PAYNE
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Credential | MD
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Telephone | 949-588-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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