Individual provider Active NPI

Maria Petrova Pesheva, M.D.

  • Ophthalmology Physician
  • Monterey Park, CA
National Provider Identifier
1073557351
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
A88707 Issued in CA
Practice address
850 S Atlantic Blvd Ste 301
Monterey Park, CA 91754-6710
Phone
(626) 289-7699
NPI assigned
Jun 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X A88707 CA Primary

Addresses

Primary practice location

850 S Atlantic Blvd Ste 301
Monterey Park, CA 91754-6710

Mailing address

850 S Atlantic Blvd Ste 301
Monterey Park, CA 91754-6710
Phone (626) 289-7699

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20050705000890 CA Practitioner - Ophthalmology 4789655879 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1255 W Arrow Hwy
San Dimas, CA 91773-2340
Phone (909) 394-2526

12761 Schabarum Ave
Irwindale, CA 91706-6807
Phone (877) 608-0044

13652 Cantara St
Panorama City, CA 91402-5423
Phone (818) 375-2000

615 W Ave L
Lancaster, CA 93534-7211
Phone (661) 729-7100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A88707CAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Paul T Urrea M D M P H Inc Ophthalmology CurrentSince Jun 20, 2009 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 26, 2020 Accepting new patients

Locations

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

1720 E Cesar E Chavez Ave
Los Angeles, CA 90033
Phone (323) 260-5781

1700 E Cesar E Chavez Ave
Ste L300
Los Angeles, CA 90033
Phone (323) 980-9900

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

4560 E Cesar E Chavez Ave
Los Angeles, CA 90022
Phone (323) 269-0411

850 S Atlantic Blvd
Ste 301
Monterey Park, CA 91754
Phone (626) 289-7699

900 S Atlantic Blvd
Monterey Park, CA 91754
Phone (626) 457-7450

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1255 W Arrow Hwy
San Dimas, CA 91773
Phone (909) 394-2526

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1073557351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 S ATLANTIC BLVD STE 301",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917546710",
            "telephone_number": "626-289-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 S ATLANTIC BLVD STE 301",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917546710",
            "telephone_number": "626-289-7699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PESHEVA",
        "first_name": "MARIA",
        "middle_name": "PETROVA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-16",
        "last_updated": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A88707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "43112 15th St W",
            "city": "Lancaster",
            "state": "CA",
            "country_code": "US",
            "postal_code": "935346219",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Monterey Park, CA

Sources for this page

Verify at the official NPI Registry.