MEDICARE: JJ&R EMERGENCY MEDICAL GROUP OF CALIFORNIA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1497704738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJ&R EMERGENCY MEDICAL GROUP OF CALIFORNIA, INC.

Provider Business Mailing Address
First Line	:	1700 EAST WALNUT AVENUE
Second Line	:	#250
City	:	EL SAGUNDO
State	:	CA
Zip	:	90245-2605
Country	:	US
Telephone Number	:	310-301-2030
Fax Number	:	310-306-5247

Provider Business Practice Location Address
First Line	:	1250 16TH ST
Second Line	:	EMERGENCY DEPARTMENT
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1249
Country	:	US
Telephone Number	:	310-319-4000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT &CEO
Name	:	BARRY B. STAUM
Credential	:	M.D.
Telephone Number	:	310-301-2030

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	11/12/2008

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