NPIMap

Individual provider Active NPI

Michelle Ann Putnam, M.D.

  • Otolaryngology Physician
  • Culver City, CA
National Provider Identifier
1063584092
Registry record updated Mar 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
A83674 Issued in CA
Practice address
3831 Hughes Ave
Suite 504
Culver City, CA 90232-2751
Phone
(310) 204-4111
Fax
(310) 204-4474
NPI assigned
Nov 14, 2006
Last updated
Mar 6, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 6, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X A83674 CA Primary
Facial Plastic Surgery Physician 207YS0123X A83674 CA
Otolaryngic Allergy Physician 207YX0602X A83674 CA

Addresses

Primary practice location

3831 Hughes Ave
Suite 504
Culver City, CA 90232-2751

Mailing address

3831 Hughes Ave
Ste 704
Culver City, CA 90232-6839
Phone (310) 204-4111

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
I20040420001881 CA Practitioner - Otolaryngology 6709872476 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Albany Medical College of Union University, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Westside Head and NeckGroup PAC ID 9830367002, 6 clinicians

Practice addresses (Care Compare)

1301 20TH St
Suite 510
Santa Monica, CA 90404-2054
Phone (310) 204-4474

3831 Hughes Ave
Culver City, CA 90232-6808
Phone (310) 204-4111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Westside Head & Neck Otolaryngology CurrentSince Jun 1, 2011 Accepting new patients
Dignity Health Past Accepting new patients
Providence Saint John's Health Center Past Accepting new patients
Aalpha Surgical Center Inc Past Accepting new patients
Southern California Healthcare System, Inc Past Accepting new patients
Brotman Medical Center, Inc. Past Accepting new patients
The Regents of the University of California Past Accepting new patients

Locations

3831 Hughes Ave
Ste 504
Culver City, CA 90232
Phone (310) 204-3376

3831 Hughes Ave
Ste 704
Culver City, CA 90232
Phone (310) 207-3320

1301 20th St
Ste 510
Santa Monica, CA 90404
Phone (310) 828-6165

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: michelle.putnam@881.chartlogic.direct-ci.com

Organizations & group practices 9

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 1

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": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583452800000",
    "number": "1063584092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3831 HUGHES AVE",
            "address_2": "STE 704",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902326839",
            "telephone_number": "310-204-4111",
            "fax_number": "310-204-4474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3831 HUGHES AVE",
            "address_2": "SUITE 504",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322751",
            "telephone_number": "310-204-4111",
            "fax_number": "310-204-4474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTNAM",
        "first_name": "MICHELLE",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "A83674",
            "primary": true
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": "CA",
            "license": "A83674",
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": "CA",
            "license": "A83674",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

Verify at the official NPI Registry.