NPIMap

Individual provider Active NPI

Gor Agababian, M.D.

  • General Practice Physician
  • Glendale, CA
National Provider Identifier
1063442143
Registry record updated Mar 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A93668 Issued in CA
Practice address
800 S Central Ave
Suite # 301
Glendale, CA 91204-4370
Phone
(818) 246-1824
Fax
(818) 246-1886
NPI assigned
Jul 4, 2006
Last updated
Mar 30, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A93668 CA Primary

Addresses

Primary practice location

800 S Central Ave
Suite # 301
Glendale, CA 91204-4370

Mailing address

800 S Central Ave
Suite #301
Glendale, CA 91204-4370
Phone (818) 246-1824

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
I20060821000504 CA Practitioner - General Practice 4789687351 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1311 N San Fernando Blvd
Burbank, CA 91504-4236
Phone (818) 843-9900

6608 San Fernando Rd
Glendale, CA 91201-1703
Phone (818) 246-1824

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A93668CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
All-Inclusive Community Health Center CurrentSince Nov 15, 2011 Accepting new patients
All-Inclusive Community Health Center CurrentSince Nov 15, 2011 Accepting new patients
Agababian Medical Clinic, Inc General Practice CurrentSince Nov 15, 2009 Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients

Locations

1311 N San Fernando Blvd
Burbank, CA 91504
Phone (818) 843-9900

6608 San Fernando Rd
Glendale, CA 91201
Phone (818) 246-1824

800 S Central Ave
Ste 301
Glendale, CA 91204
Phone (747) 273-7088

3920 Eagle Rock Blvd
Ste A
Los Angeles, CA 90065
Phone (323) 255-5225

17114 Devonshire St
Ste 101
Northridge, CA 91325
Phone (818) 998-6000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/HCAEBA/Endpoint/HCAEBA

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
All-Inclusive Community Health CenterLos Angeles, CA, CCN 751834 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Nov 15, 2011
Nov 15, 2011

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 4

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": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1333065600000",
    "number": "1063442143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S CENTRAL AVE",
            "address_2": "SUITE #301",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912044370",
            "telephone_number": "818-246-1824",
            "fax_number": "818-246-1886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S CENTRAL AVE",
            "address_2": "SUITE # 301",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912044370",
            "telephone_number": "818-246-1824",
            "fax_number": "818-246-1886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGABABIAN",
        "first_name": "GOR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-04",
        "last_updated": "2012-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A93668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.