Maryam Farazha, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A101291 Issued in CA

Practice address

1821 Wilshire Blvd Ste 100
Santa Monica, CA 90403-5627

Phone

(310) 575-3100

Fax

(310) 575-3102

NPI assigned

Jun 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

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

Family Practice

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Saint Johns Medical FoundationGroup PAC ID 0840548624, 282 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

90.42 of 100Reported as group

Quality

96.07

Promoting interoperability

100

Improvement activities

40

Cost

71.98

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Providence Saint Johns Medical Foundation

  dba Saint John's Physician Partners

  • Specialist
  • Santa Monica, CA
  • NPI 1770093734

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Providence Saint John's Health Center

  • General Acute Care Hospital
  • Santa Monica, CA
  • NPI 1124026273
  NPD (past)
• Associates in Family Practice PA

  • Family Medicine Physician
  • Silver Spring, MD
  • NPI 1376736603
  NPD (past)
• Dr. Benjamin F. Papoi, P.C.

  dba PR Family Medicine

  • Family Medicine Physician
  • Damascus, MD
  • NPI 1740212893
  NPD (past)
• John Kijak Jr MD PA

  • Family Medicine Physician
  • Damascus, MD
  • NPI 1720010333
  NPD (past)

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1063416840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 WILSHIRE BLVD STE 100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035627",
            "telephone_number": "310-575-3100",
            "fax_number": "310-575-3102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 WILSHIRE BLVD STE 100",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035627",
            "telephone_number": "310-575-3100",
            "fax_number": "310-575-3102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARAZHA",
        "first_name": "MARYAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-09",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D0060512",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A101291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI",
            "identifier": "8127890",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BLUE CHOICE",
            "identifier": "K249 0002",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST BC/BS OF MD",
            "identifier": "64147501",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mfarazha473448@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1821 Wilshire Blvd Ste 100",
            "city": "Santa Monica",
            "state": "CA",
            "country_code": "US",
            "postal_code": "904035627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole Fanucci
• Far East Holistic Health Care Center Inc
• Carole Farah, DDS
• Elham Farahmand, D.D.S
• Rene Farahmandian, PA
• David N Farchadi, MD, MS, MS
• Farinoush Gaminchi DMD Inc
• Claire Hamilton Farmer, PA-C
• Marissa Farmon, PMHNP-BC
• Lenora Farnam-Fard, PHARMD

• Family Medicine Physician in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.