NPIMap

Individual provider Active NPI

Alan Fozailoff, M.D.

  • Nephrology Physician
  • Tarzana, CA
National Provider Identifier
1053331595
Registry record updated Jan 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A76164 Issued in CA
Practice address
18370 Burbank Blvd
Suite 211
Tarzana, CA 91356-2804
Phone
(818) 334-5750
Fax
(951) 272-9924
NPI assigned
Jul 20, 2006
Last updated
Jan 10, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A76164 CA Primary

Addresses

Primary practice location

18370 Burbank Blvd
Suite 211
Tarzana, CA 91356-2804

Mailing address

PO Box 77790
Corona, CA 92877-0126
Phone (951) 278-5590

Other identifiers 3

IdentifierTypeStateIssuer
00A761640MedicaidCA
A76164OtherCALICENSE
00A761640OtherCABLUE SHILELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040727001355 CA Practitioner - NephrologyPractitioner - Internal Medicine 3971573072 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Albert Einstein College of Medicine of Yeshiva University, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

18370 Burbank Blvd
Suite 211
Tarzana, CA 91356-2854
Phone (818) 334-5750

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40
Cost
69.29

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A76164CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alan Fozailoff MD Inc Nephrology CurrentSince Mar 13, 2015 Accepting new patients
Motion Picture and Television Fund Medical Group Inc Past Accepting new patients
West Hills Hospital Past Accepting new patients
Tarzana Medical Center LLC Past Accepting new patients
Motion Picture and Television Fund Medical Group, Inc Past Accepting new patients

Locations

16311 Ventura Blvd
Ste 1255
Encino, CA 91436
Phone (818) 232-5670

18370 Burbank Blvd
Ste 211
Tarzana, CA 91356
Phone (818) 334-5750

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: alan.fozailoff@5436357410820.direct.elationemr.com

Organizations & group practices 5

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 5

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484006400000",
    "number": "1053331595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 77790",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928770126",
            "telephone_number": "951-278-5590",
            "fax_number": "951-272-9924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18370 BURBANK BLVD",
            "address_2": "SUITE 211",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913562804",
            "telephone_number": "818-334-5750",
            "fax_number": "951-272-9924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOZAILOFF",
        "first_name": "ALAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2017-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A76164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A761640",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A76164",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHILELD",
            "identifier": "00A761640",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarzana, CA

Sources for this page

Verify at the official NPI Registry.