Individual provider Active NPI

Shahram Shawn Farahvash, M.D.

  • Anesthesiology Physician
  • Van Nuys, CA
National Provider Identifier
1003076621
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
56705 Issued in WI
Practice address
15107 Vanowen St
Van Nuys, CA 91405-4542
Phone
(818) 782-6600
NPI assigned
Jun 17, 2008
Last updated
Dec 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 56705 WI Primary
Pediatric Anesthesiology Physician 207LP3000X A115190 CA

Addresses

Primary practice location

15107 Vanowen St
Van Nuys, CA 91405-4542

Mailing address

15107 Vanowen St
Pediatric Anesthesiology
Van Nuys, CA 91405-4542
Phone (818) 782-6600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140416002409 CA Practitioner - Anesthesiology 9830355122 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Valley Medical GroupGroup PAC ID 3577465368, 104 clinicians
VP Anesthesia Partners IncGroup PAC ID 6002283363, 19 clinicians

Practice addresses (Care Compare)

100 W California Blvd
Pasadena, CA 91105-3010
Phone (626) 440-9161

210 W San Bernardino Rd
Covina, CA 91723-1515
Phone (310) 698-5486

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.45 of 100Reported as group
Quality
77
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
56705WIMDAnesthesiology Physician
A115190CAMDPediatric Anesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
VP Anesthesia Partners, Inc Anesthesiology CurrentSince Sep 1, 2022 Accepting new patients
Health Alliance Socal, Inc Past Accepting new patients

Locations

210 W San Bernardino Rd
Covina, CA 91723
Phone (626) 858-8580

15107 Vanowen St
Van Nuys, CA 91405
Phone (818) 782-6600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1213660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1003076621",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15107 VANOWEN ST",
            "address_2": "PEDIATRIC ANESTHESIOLOGY",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914054542",
            "telephone_number": "818-782-6600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15107 VANOWEN ST",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914054542",
            "telephone_number": "818-782-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARAHVASH",
        "first_name": "SHAHRAM",
        "middle_name": "SHAWN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-17",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "56705",
            "primary": true
        },
        {
            "code": "207LP3000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "CA",
            "license": "A115190",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Van Nuys, CA

Sources for this page

Verify at the official NPI Registry.