Kian Raiszadeh, MD

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

A99221 Issued in CA

Practice address

2725 Ridgegate Row
La Jolla, CA 92037-0915

Phone

(201) 600-4903

NPI assigned

Jul 18, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Orthopedic Surgery

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

DHP of California Medical Group IncGroup PAC ID 9234388745, 12 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grossmont Hospital Hospital, La Mesa, CA, CCN 050026

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• DHP of California Medical Group Inc

  • Obstetrics & Gynecology Physician
  • Stockton, CA
  • NPI 1679836084
  Medicare reassignment Care Compare group NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• Spinezone Medical Fitness, Inc.

  • Physical Therapist
  • Del Mar, CA
  • NPI 1720517428
  NPD (past)

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

• Grossmont Hospital Corporation

  • General Acute Care Hospital
  • La Mesa, CA
  • NPI 1528041811
  Care Compare affiliation

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

{
    "created_epoch": "1184716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1013117183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2725 RIDGEGATE ROW",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920370915",
            "telephone_number": "201-600-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2725 RIDGEGATE ROW",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920370915",
            "telephone_number": "201-600-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAISZADEH",
        "first_name": "KIAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-18",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "A99221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alexis Sami Rahal, M.D.
• Mirza Raheem, M.D.
• Shima Rahgozar
• Bahar Rahnamayi
• Jagwant Rai, PHARM.D
• Varuna Raizada, MBBS
• Gabrielle Kavya Rajulu, MD
• Jeffrey S. Rakoff, M.D.
• Ralph E Schrock Optometric Corporation
• Ralphs Grocery Company

• Sports Medicine (Orthopaedic Surgery) Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.