Individual provider Active NPI

Sarah Olivia Yaghoubi, PT, DPT

  • Neurology Physical Therapist
  • Pomona, CA
National Provider Identifier
1104650217
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology Physical TherapistTaxonomy code 2251N0400X
License
304826 Issued in CA
Practice address
255 E Bonita Ave
Pomona, CA 91767-1923
Phone
(909) 596-7733
NPI assigned
Aug 29, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physical Therapist 2251N0400X 304826 CA Primary

Addresses

Primary practice location

255 E Bonita Ave
Pomona, CA 91767-1923

Mailing address

2619 Timberlake Dr
La Crescenta, CA 91214-1447
Phone (818) 454-6508

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024001400 CA Practitioner - Physical Therapist in Private Practice 2769915123 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Loma Linda University School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

1526 N Edgemont St
Los Angeles, CA 90027-5260
Phone (323) 783-4011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
304826CAMDNeurology Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Oct 1, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 1, 2024 Accepting new patients

Locations

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

1526 N Edgemont St
Los Angeles, CA 90027
Phone (323) 783-8070

393 E Walnut St
Fl 5
Pasadena, CA 91188
Phone (310) 403-3235

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1724889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1104650217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2619 TIMBERLAKE DR",
            "city": "LA CRESCENTA",
            "state": "CA",
            "postal_code": "912141447",
            "telephone_number": "818-454-6508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 E BONITA AVE",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671923",
            "telephone_number": "909-596-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YAGHOUBI",
        "first_name": "SARAH",
        "middle_name": "OLIVIA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-29",
        "last_updated": "2024-10-25",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": "CA",
            "license": "304826",
            "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": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.