Individual provider Active NPI

Sevak Aghazaryan

  • Acute Care Nurse Practitioner
  • Sunland, CA
National Provider Identifier
1104584481
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
95018713 Issued in CA
Practice address
8026 Wentworth St
Sunland, CA 91040-2139
Phone
(818) 726-8010
NPI assigned
Dec 3, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 95018713 CA Primary

Addresses

Primary practice location

8026 Wentworth St
Sunland, CA 91040-2139

Mailing address

8026 Wentworth St
Sunland, CA 91040-2139
Phone (818) 726-8010

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220607002778 CA Practitioner - Nurse Practitioner 1658759451 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1511 W Glenoaks Blvd
Glendale, CA 91201-1912
Phone (818) 637-2200

Hospital & facility affiliations

  • Glendale Adventist Medical Center Hospital, Glendale, CA, CCN 050239
  • Glendale Mem Hospital & HLTH Center Hospital, Glendale, CA, CCN 050058

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95018713CAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Pulmonary & Critical Care Associates Inc. CurrentSince Feb 23, 2022 Accepting new patients

Locations

1511 W Glenoaks Blvd
Glendale, CA 91201
Phone (818) 637-2200

1560 E Chevy Chase Dr
Ste 355
Glendale, CA 91206
Phone (747) 212-3441

Organizations & group practices 1

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 2

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": "1638489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1104584481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8026 WENTWORTH ST",
            "city": "SUNLAND",
            "state": "CA",
            "postal_code": "910402139",
            "telephone_number": "818-726-8010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8026 WENTWORTH ST",
            "city": "SUNLAND",
            "state": "CA",
            "postal_code": "910402139",
            "telephone_number": "818-726-8010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGHAZARYAN",
        "first_name": "SEVAK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-03",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95018713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sunland, CA

Sources for this page

Verify at the official NPI Registry.