NPIMap

Individual provider Active NPI

Edmond Derderian, M.D.

  • Internal Medicine Physician
  • Sherman Oaks, CA
National Provider Identifier
1114258944
Registry record updated Oct 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A110089 Issued in CA
Practice address
4955 Van Nuys Blvd Ste 308
Sherman Oaks, CA 91403-1811
Phone
(818) 528-1044
Fax
(818) 817-0845
NPI assigned
Jan 18, 2010
Last updated
Oct 24, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2019

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 A110089 CA Primary

Addresses

Primary practice location

4955 Van Nuys Blvd Ste 308
Sherman Oaks, CA 91403-1811

Mailing address

4955 Van Nuys Blvd Ste 308
Sherman Oaks, CA 91403-1811

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110127000049 CA Practitioner - Internal Medicine 2668651340 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Epic Medical Group,IncGroup PAC ID 4385883958, 54 clinicians
Health Lync Medical Group IncGroup PAC ID 4587109913, 8 clinicians

Practice addresses (Care Compare)

16850 Bear Valley Rd
Victorville, CA 92395-5794
Phone (760) 241-8000

3621 Martin Luther King Jr Blvd
Suite 6
Lynwood, CA 90262-3512
Phone (310) 772-1108

3630 E Imperial Hwy
Lynwood, CA 90262-2609
Phone (818) 528-1044

4940 Van Nuys Blvd
Suite 200
Sherman Oaks, CA 91403-1741
Phone (818) 528-1260

4955 Van Nuys Blvd
Suite 308
Sherman Oaks, CA 91403-1811
Phone (818) 387-6114

5451 Walnut Ave
Chino, CA 91710-2609
Phone (909) 464-8600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Epic Medical Group,Inc Internal Medicine CurrentSince May 8, 2013 Accepting new patients
One Health Medical Group Inc CurrentSince Apr 1, 2022 Accepting new patients
Derderyan Medical Group Inc. Internal Medicine CurrentSince Apr 1, 2016 Accepting new patients
Health Lync Medical Group, Inc. CurrentSince Jun 1, 2024 Accepting new patients
Armen Hovhannisyan MD Group Inc Past Accepting new patients

Locations

501 W Glenoaks Blvd
Ste 26
Glendale, CA 91202

3621 Martin Luther King Jr Blvd
Ste 6
Lynwood, CA 90262
Phone (310) 537-1503

3630 E Imperial Hwy
Ste 55B
Lynwood, CA 90262
Phone (213) 602-9004

4940 Van Nuys Blvd
Ste 200
Sherman Oaks, CA 91403
Phone (818) 528-1222

4929 Van Nuys Blvd
Van Nuys, CA 91403
Phone (818) 907-4561

4955 Van Nuys Blvd
Ste 308
Van Nuys, CA 91403
Phone (818) 387-6114

16850 Bear Valley Rd
Victorville, CA 92395

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7032/brand/1/csg/1/fhir/r4
  • Direct secure messaging: soh-ederderyan@primehealthcare.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Valley Palms Care CenterNorth Hollywood, CA, CCN 055287 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jul 2, 2013
Jul 2, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • 13400 Sherman Way LLC

    dba Valley Palms Care Center

    • Skilled Nursing Facility
    • North Hollywood, CA
    • NPI 1801881479

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1263772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1114258944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4955 VAN NUYS BLVD STE 308",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4955 VAN NUYS BLVD STE 308",
            "city": "SHERMAN OAKS",
            "state": "CA",
            "postal_code": "914031811",
            "telephone_number": "818-528-1044",
            "fax_number": "818-817-0845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERDERIAN",
        "first_name": "EDMOND",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-01-18",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A110089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sherman Oaks, CA

Sources for this page

Verify at the official NPI Registry.