Individual provider Active NPI

Nagesh Ragavendra, MD

  • Diagnostic Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1063528206
Registry record updated Dec 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
A51254 Issued in CA
Practice address
100 UCLA Medical PLZ Ste 100
Los Angeles, CA 90024-7000
Phone
(310) 301-6800
Fax
(310) 794-9035
NPI assigned
Aug 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Ultrasound Physician 2085U0001X A51254 CA
Diagnostic Radiology Physician 2085R0202X A51254 CA Primary

Addresses

Primary practice location

100 UCLA Medical PLZ Ste 100
Los Angeles, CA 90024-7000

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other practice location 1

757 Westwood Plz Ste 1501
Los Angeles, CA 90095-3075
Phone (310) 301-6800

Other practice location 2

200 Ucla Medical Plz Ste B165-76
Los Angeles, CA 90095-3075
Phone (310) 301-6800

Other practice location 3

200 Ucla Medical Plz Ste B165
Los Angeles, CA 90095-3075
Phone (310) 301-6800

Other identifiers 1

IdentifierTypeStateIssuer
00A512540MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A51254CAMDDiagnostic Ultrasound Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents Univ of Calif Los Angeles Past Accepting new patients

Organizations & group practices 1

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": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576627200000",
    "number": "1063528206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 UCLA MEDICAL PLZ STE 100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900247000",
            "telephone_number": "310-301-6800",
            "fax_number": "310-794-9035"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "757 Westwood Plz Ste 1501",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900953075",
            "country_code": "US",
            "telephone_number": "310-301-6800",
            "fax_number": "310-794-9035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Ucla Medical Plz Ste B165-76",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900953075",
            "country_code": "US",
            "telephone_number": "310-301-6800",
            "fax_number": "310-794-9035",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 Ucla Medical Plz Ste B165",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900953075",
            "country_code": "US",
            "telephone_number": "310-301-6800",
            "fax_number": "310-794-9035",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAGAVENDRA",
        "first_name": "NAGESH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2019-12-18",
        "certification_date": "2019-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085U0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "CA",
            "license": "A51254",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A51254",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A512540",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.