NPIMap

Organization Active NPI

Antelope Valley Neuroscience

  • Neurology Physician
  • Lancaster, CA
National Provider Identifier
1114912979
Registry record updated Oct 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
ANTELOPE VALLEY NEUROSCIENCE
Practice address
42135 10TH St W
Suite 301
Lancaster, CA 93534-7095
Phone
(661) 945-6931
Fax
(661) 945-4592
NPI assigned
Sep 16, 2005
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Abdallah S Farrukh, MDNPI 1932135266
Title
Partner
Phone
(661) 945-6931

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20041123000496 CA Part B Supplier - Clinic/Group Practice 0345205944 Receives reassigned benefits from 7 practitioners
Practice locations: Lancaster, CA; Ridgecrest, CA

National Provider Directory

National Provider Directory

Locations

44902 10th St W
Lancaster, CA 93534
Phone (661) 305-2853

913 Alene Ave
Ste B
Ridgecrest, CA 93555
Phone (760) 446-6030

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207T00000X
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X NP20677 CA

Addresses

NPPES NPI Registry

Primary practice location

42135 10TH St W
Suite 301
Lancaster, CA 93534-7095

Mailing address

42135 10TH St W
Suite 301
Lancaster, CA 93534-7095
Phone (661) 945-6931

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
ZZZ83620ZMedicaidCA

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 7, 2014.

{
    "created_epoch": "1126828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412640000000",
    "number": "1114912979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42135 10TH ST W",
            "address_2": "SUITE 301",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935347095",
            "telephone_number": "661-945-6931",
            "fax_number": "661-945-4592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42135 10TH ST W",
            "address_2": "SUITE 301",
            "city": "LANCASTER",
            "state": "CA",
            "postal_code": "935347095",
            "telephone_number": "661-945-6931",
            "fax_number": "661-945-4592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTELOPE VALLEY NEUROSCIENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-16",
        "last_updated": "2014-10-07",
        "status": "A",
        "authorized_official_last_name": "FARRUKH",
        "authorized_official_first_name": "ABDALLAH",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "661-945-6931",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP20677",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ83620Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.