Individual provider Active NPI

Jilbert Eradat, M.D.

  • Vascular & Interventional Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1083927115
Registry record updated Aug 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
A107977 Issued in CA
Practice address
10866 Wilshire Blvd
Suite 400 - PMB 278
Los Angeles, CA 90024-4300
Phone
(310) 000-0000
NPI assigned
Jul 19, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology Physician 2085R0204X A107977 CA Primary
Diagnostic Radiology Physician 2085R0202X A107977 CA

Addresses

Primary practice location

10866 Wilshire Blvd
Suite 400 - PMB 278
Los Angeles, CA 90024-4300

Mailing address

631 W Avenue Q
Ste a
Palmdale, CA 93551-3892

Other identifiers 2

IdentifierTypeStateIssuer
1083927115MedicaidCA
00A1079770OtherCABCBS OF CA

Other names 1

  • Gilbert Eradat Other name

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
I20110829000301 CA Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 5294905394 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional RadiologyAlso: Diagnostic Radiology
Education
University of California, San Diego School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

631 W Ave Q
Suite a
Palmdale, CA 93551-3892
Phone (661) 480-5956

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal115
Leg revascularization (restoring blood flow)43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A107977CAMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Interventional Institute, Inc CurrentSince Sep 19, 2016 Accepting new patients
Tower Imaging Medical Group, Inc Diagnostic Radiology Past Accepting new patients

Locations

631 W Avenue Q
Ste A
Palmdale, CA 93551
Phone (661) 480-5956

38780 Trade Center Dr
Ste 1C
Palmdale, CA 93551
Phone (661) 947-5600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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 3

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": "1279497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471737600000",
    "number": "1083927115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 W AVENUE Q",
            "address_2": "STE A",
            "city": "PALMDALE",
            "state": "CA",
            "postal_code": "935513892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10866 WILSHIRE BLVD",
            "address_2": "SUITE 400 - PMB 278",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900244300",
            "telephone_number": "310-000-0000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERADAT",
        "first_name": "JILBERT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-19",
        "last_updated": "2016-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": "A107977",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "A107977",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1083927115",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF CA",
            "identifier": "00A1079770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GILBERT",
            "last_name": "ERADAT",
            "credential": "M.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.