Individual provider Active NPI

Mehdi Razeghi

  • Internal Medicine Physician
  • Glendale, CA
National Provider Identifier
1063454510
Registry record updated Apr 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A94467 Issued in CA
Practice address
777 Flower St Ste a
Glendale, CA 91201-3000
Phone
(818) 637-2000
Fax
(818) 242-8761
NPI assigned
Jun 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A94467 CA Primary

Addresses

Primary practice location

777 Flower St Ste a
Glendale, CA 91201-3000

Mailing address

777 Flower St Ste a
Glendale, CA 91201-3000
Phone (818) 637-2000

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
I20071015000178 CA Practitioner - Internal Medicine 5991891491 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A94467CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeside Medical Organization, a Medical Group Inc. Internal Medicine CurrentSince Mar 17, 2010 Accepting new patients
Lakeside Medical Associates, a Medical Group, Inc. Internal Medicine Past Accepting new patients

Locations

191 S Buena Vista St
Ste 420440
Burbank, CA 91505
Phone (818) 848-0023

191 S Buena Vista St
Ste 200
Burbank, CA 91505
Phone (818) 887-2671

1500 S Central Ave
Ste 200
Glendale, CA 91204
Phone (818) 242-8916

777 Flower St
Ste A
Glendale, CA 91201
Phone (818) 637-2000

8510 Balboa Blvd
Ste 150
Northridge, CA 91325
Phone (818) 637-2000

7345 Medical Center Dr
Ste 500
West Hills, CA 91307
Phone (818) 348-6200

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: mehdi.razeghi.p1@direct.lakeside.nextgenshare.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302825600000",
    "number": "1063454510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 FLOWER ST STE A",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912013000",
            "telephone_number": "818-637-2000",
            "fax_number": "818-242-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 FLOWER ST STE A",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912013000",
            "telephone_number": "818-637-2000",
            "fax_number": "818-242-8761"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAZEGHI",
        "first_name": "MEHDI",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-11",
        "last_updated": "2011-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A94467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.