NPIMap

Individual provider Active NPI

Herach Yadegarian, M.D.

  • General Practice Physician
  • Glendale, CA
National Provider Identifier
1124188628
Registry record updated Sep 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A49305 Issued in CA
Practice address
800 S. Central Ave.
Suite 308
Glendale, CA 91204-4644
Phone
(818) 240-8767
Fax
(818) 502-0254
NPI assigned
Dec 12, 2006
Last updated
Sep 4, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A49305 CA Primary

Addresses

Primary practice location

800 S. Central Ave.
Suite 308
Glendale, CA 91204-4644

Mailing address

800 S. Central Ave.
Suite 308
Glendale, CA 91204-4644
Phone (818) 240-8767

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
I20070607000334 CA Practitioner - General Practice 7618921818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1972
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

411 N Central Ave
Suite 130
Glendale, CA 91203-2092
Phone (818) 240-8767

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

State licenses

LicenseStateTypeSpecialty
49305CAMDMarriage & Family Therapist
A49305CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Herach Yadegarian, M.D., a Medical Corporation General Practice CurrentSince Mar 12, 2007 Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients

Locations

411 N Central Ave
Ste 130
Glendale, CA 91203
Phone (818) 240-8767

800 S Central Ave
Ste 308
Glendale, CA 91204
Phone (818) 332-2233

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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 12

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": "1165881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252022400000",
    "number": "1124188628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 S. CENTRAL AVE.",
            "address_2": "SUITE 308",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912044644",
            "telephone_number": "818-240-8767",
            "fax_number": "818-502-0254"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S. CENTRAL AVE.",
            "address_2": "SUITE 308",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912044644",
            "telephone_number": "818-240-8767",
            "fax_number": "818-502-0254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YADEGARIAN",
        "first_name": "HERACH",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-12",
        "last_updated": "2009-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A49305",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.