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PACIFIC PALISADES MEDICAL GROUP INC.
NPI 1215037049
Family Medicine in Pacific Palisades, CA

Active since September 22, 2006CLIA 05D1028348 · Waiver
15200 W SUNSET BLVD, SUITE 107, PACIFIC PALISADES, CA 90272(310) 459-7736(310) 230-0284 Get Directions Write a Review

NPPES record last updated: May 14, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Pacific Palisades Medical Group Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PACIFIC PALISADES MEDICAL GROUP INC. (NPI 1215037049) is a healthcare organization registered as a family medicine in Pacific Palisades, California and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through July 21, 2028 and lists Richard Johnson, President, as its authorized official.

NPPES Registry Identity

NPI1215037049
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NamePACIFIC PALISADES MEDICAL GROUP INC.
Location Address15200 W SUNSET BLVD, SUITE 107Pacific Palisades, CA 90272-3619
Mailing Address15200 W Sunset Blvd, Suite 107Pacific Palisades, CA 90272-3619 · (310) 459-7736 · Fax (310) 230-0284
Phone(310) 459-7736
Fax(310) 230-0284
Organization SubpartNo
Authorized OfficialRichard JohnsonPresident · (310) 459-7736
Enumeration DateSeptember 22, 2006
Last NPPES UpdateMay 14, 2021
NPPES CertifiedMay 14, 2021
✔ NPI 1215037049 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
15200 W SUNSET BLVD, Pacific Palisades, CA 90272
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pacific Palisades Medical Group Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Pacific Palisades Medical Group Inc., which bills Medicare for the services they deliver. Of these, 3 practice at this address and 5 within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Ericka Gair, D.O.
Family Practice
NPI 1376660704
15200 W SUNSET BLVD STE 107
Pacific Palisades, CA 90272
(310) 459-7736
✔ PECOS✔ Accepts MedicareSame address
Richard Johnson, MD
Internal Medicine
NPI 1770596009
15200 W SUNSET BLVD STE 107
Pacific Palisades, CA 90272
(310) 459-7736
✔ PECOSSame address
Julie Ma, MD
Internal Medicine
NPI 1306865688
15200 W SUNSET BLVD STE 107
Pacific Palisades, CA 90272
(310) 459-7736
✔ PECOS✔ Accepts MedicareSame address
Gary Green, MD
Family Practice
NPI 1154345254
881 ALMA REAL DR STE 101
Pacific Palisades, CA 90272
(310) 829-8923
✔ PECOS✔ Accepts Medicare0.1 mi
Krystyna Mcnicoll, MD
Family Practice
NPI 1750392247
881 ALMA REAL DR STE 101
Pacific Palisades, CA 90272
(310) 829-8923
✔ PECOS0.1 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D1028348

Pacific Palisades Medical Group Inc · Santa Monica, CA
Active · expires Jul 21, 2028
CLIA Number05D1028348
Laboratory TypePhysician Office
Certificate Effective DateJuly 22, 2026
Certificate Expiration DateJuly 21, 2028
Laboratory DirectorJulie Ma
Laboratory Phone(310) 459-7736
Laboratory LocationPacific Palisades Medical Group Inc2730 Wilshire Blvd Ste 301, Santa Monica, CA 90403
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Pacific Palisades Medical Group Inc.'s NPI number?

The NPI number for Pacific Palisades Medical Group Inc. is 1215037049. It was assigned to this organization in the NPPES registry on September 22, 2006.

Where is Pacific Palisades Medical Group Inc. located?

Pacific Palisades Medical Group Inc. is located at 15200 W Sunset Blvd Suite 107, Pacific Palisades, CA 90272. The listed phone number is (310) 459-7736.

What is Pacific Palisades Medical Group Inc.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Pacific Palisades Medical Group Inc. enrolled in Medicare?

Yes. Pacific Palisades Medical Group Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pacific Palisades Medical Group Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Pacific Palisades Medical Group Inc.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Family Practice (3) and Internal Medicine (2). Of these, 3 practice at this address and 5 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Pacific Palisades Medical Group Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D1028348) is associated with this NPI, valid through July 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Pacific Palisades Medical Group Inc. was last updated on May 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.