P.B. Nikravesh DPM, Apc

Primary specialty

Primary Podiatric Medicine PodiatristTaxonomy code 213EP1101X

License

E4103 Issued in CA

Legal business name

P.B. NIKRAVESH DPM, APC

Practice address

6404 Wilshire Blvd Ste 600
Los Angeles, CA 90048-5501

Phone

(323) 782-8586

Fax

(323) 782-8528

NPI assigned

Jul 16, 2012

Last updated

Jul 16, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Yvette Ureta

Title

Medical Assistant

Phone

(323) 782-8586

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Locations

Practitioners 1

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.

• Payam Benjamin Nikravesh, DPM

  • Foot & Ankle Surgery Podiatrist
  • Los Angeles, CA
  • NPI 1437192200
  Medicare reassignment NPD

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342396800000",
    "number": "1083969018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6404 WILSHIRE BLVD STE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485501",
            "telephone_number": "323-782-8586",
            "fax_number": "323-782-8528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6404 WILSHIRE BLVD STE 600",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900485501",
            "telephone_number": "323-782-8586",
            "fax_number": "323-782-8528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P.B. NIKRAVESH DPM, APC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-16",
        "last_updated": "2012-07-16",
        "status": "A",
        "authorized_official_last_name": "URETA",
        "authorized_official_first_name": "YVETTE",
        "authorized_official_title_or_position": "MEDICAL ASSISTANT",
        "authorized_official_telephone_number": "323-782-8586"
    },
    "taxonomies": [
        {
            "code": "213EP1101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Primary Podiatric Medicine",
            "state": "CA",
            "license": "E4103",
            "primary": true
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E4103",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000E41032",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "E4103",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Podiatric Medicine Podiatrist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Primary Podiatric Medicine Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2012; 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.