Individual provider Active NPI

Aydin Abyar Lathari, M.D.

  • Internal Medicine Physician
  • Newport, VT
National Provider Identifier
1073757654
Registry record updated Jul 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MT190883 Issued in PA
Practice address
186 Medical Village Dr Ste 2
Newport, VT 05855-8537
Phone
(802) 334-3523
NPI assigned
Apr 27, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2023

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 MT190883 PA Primary

Addresses

Primary practice location

186 Medical Village Dr Ste 2
Newport, VT 05855-8537

Mailing address

186 Medical Village Dr Ste 2
Newport, VT 05855-8537
Phone (802) 334-3523

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 PA, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20200130000130 PA Practitioner - Internal Medicine 9537349246 Reassigns benefits to 1 organization
I20230525001560 CA Practitioner - Internal Medicine 9537349246 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Temple University School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

9400 Rosecrans Ave
Bellflower, CA 90706-2246
Phone (562) 461-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT190883PAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jun 5, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 5, 2023 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
St. Luke'S Physician Group, Inc. CurrentSince Jan 2, 2020 Accepting new patients
24 On Physicians of California, PC CurrentSince Apr 1, 2023 Accepting new patients
St Luke'S Physician Group Inc CurrentSince Jan 2, 2020 Accepting new patients
St. Luke'S Physician Group, Inc. Current Accepting new patients

Locations

9400 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-6064

9333 Rosecrans Ave
Bellflower, CA 90706
Phone (562) 461-3340

9333 Imperial Hwy
Downey, CA 90242
Phone (562) 657-8850

1415 Ross Ave
El Centro, CA 92243
Phone (760) 339-4045

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

801 Ostrum St
Fountain Hill, PA 18015
Phone (610) 954-2200

Organizations & group practices 7

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.

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": "1240790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1073757654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "186 MEDICAL VILLAGE DR STE 2",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "058558537",
            "telephone_number": "802-334-3523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "186 MEDICAL VILLAGE DR STE 2",
            "city": "NEWPORT",
            "state": "VT",
            "postal_code": "058558537",
            "telephone_number": "802-334-3523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATHARI",
        "first_name": "AYDIN",
        "middle_name": "ABYAR",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-27",
        "last_updated": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "PA",
            "license": "MT190883",
            "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": "9333 Imperial Hwy",
            "city": "Downey",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902422812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Newport, VT

Sources for this page

Verify at the official NPI Registry.