NPIMap

Organization Active NPI

Vascular Intervention Specialists Inc

  • Vascular & Interventional Radiology Physician
  • Reseda, CA
National Provider Identifier
1063959310
Registry record updated Nov 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
Legal business name
VASCULAR INTERVENTION SPECIALISTS INC
Practice address
19231 Victory Blvd Ste 155
Reseda, CA 91335
Phone
(818) 949-2630
Fax
(818) 561-3746
NPI assigned
Jan 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2020

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

Authorized official

Name
Jack Morgan, DPM
Title
President
Phone
(310) 880-7442

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X Primary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X E1613 CA
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X

Addresses

Primary practice location

19231 Victory Blvd Ste 155
Reseda, CA 91335

Mailing address

19231 Victory Blvd Ste 155
Reseda, CA 91335-6329
Phone (818) 949-2630

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170214002134 CA Part B Supplier - Clinic/Group Practice 0547543753 Receives reassigned benefits from 17 practitioners
Practice locations: Reseda, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605744000000",
    "number": "1063959310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19231 VICTORY BLVD STE 155",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "913356329",
            "telephone_number": "818-949-2630",
            "fax_number": "818-561-3746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19231 VICTORY BLVD STE 155",
            "city": "RESEDA",
            "state": "CA",
            "postal_code": "91335",
            "telephone_number": "818-949-2630",
            "fax_number": "818-561-3746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VASCULAR INTERVENTION SPECIALISTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-25",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A",
        "authorized_official_last_name": "MORGAN",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-880-7442",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "CA",
            "license": "E1613",
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reseda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.