Sam A Ebrahimi, MD

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

A060777 Issued in CA

Practice address

18375 Ventura Blvd
Suite# 404
Tarzana, CA 91356-4218

Phone

(818) 422-5322

NPI assigned

Oct 19, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 7

Other names 1

• Sam Afkham-Ebrahimi Professional name

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Vascular SurgeryAlso: Thoracic Surgery

Education

University of California, Geffen School of Medicine, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: sam.ebrahimi.1@15388.direct.athenahealth.com

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.

• California Institute for Cardiovascular and Laser Vein Surg

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Encino, CA
  • NPI 1891092797
  Medicare reassignment Authorized official
• California Institute for CV&LVS

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Encino, CA
  • NPI 1295137016
  NPD Authorized official
• Capital Cardiovascular & Thoracic Surgery Associates, PLLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Bethesda, MD
  • NPI 1952595811
  NPD (past)
• Javanshir Janani,M.D., P.C

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Bladensburg, MD
  • NPI 1548441975
  NPD (past)
• Mosam Cardiovascular Surgery Associates LLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Cheverly, MD
  • NPI 1205826948
  NPD (past)
• Washington Cardiothoracic Surgery Assoc.,PLLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Washington, DC
  • NPI 1588606115
  NPD (past)

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

{
    "created_epoch": "1129680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1477180800000",
    "number": "1114916376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18375 VENTURA BLVD",
            "address_2": "SUITE# 404",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564218",
            "telephone_number": "301-537-7751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18375 VENTURA BLVD",
            "address_2": "SUITE# 404",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564218",
            "telephone_number": "818-422-5322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBRAHIMI",
        "first_name": "SAM",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-19",
        "last_updated": "2016-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "DC",
            "license": "MD33806",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "VA",
            "license": "0101233742",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MD",
            "license": "D0059318",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A060777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JHHC PRIORITY PARTNER",
            "identifier": "100336",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "J449-0010",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035556900",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI LIFE & HEALTH",
            "identifier": "4129526",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MARYLAND",
            "identifier": "484AWA",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00435744",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404465702",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SAM",
            "last_name": "AFKHAM-EBRAHIMI",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Tarzana, CA
• Providers in Tarzana, CA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.