Individual provider Active NPI

Hesam Hekmatjou, M.D.

  • Family Medicine Physician
  • Burbank, CA
National Provider Identifier
1124407119
Registry record updated Jul 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A151253 Issued in CA
Practice address
191 S Buena Vista St
Suite 100
Burbank, CA 91505-4554
Phone
(818) 869-7600
NPI assigned
May 22, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X CA
Family Medicine Physician 207Q00000X A151253 CA Primary

Addresses

Primary practice location

191 S Buena Vista St
Suite 100
Burbank, CA 91505-4554

Mailing address

PO Box 9602
Mission Hills, CA 91346-9602
Phone (818) 837-5559

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20180712003483 CA Practitioner - Family Practice 6406102938 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Providence Facey Medical FoundationGroup PAC ID 3173436276, 324 clinicians

Practice addresses (Care Compare)

191 S Buena Vista St
Suite 100
Burbank, CA 91505-4562
Phone (818) 869-7600

Hospital & facility affiliations

  • Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A151253CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Facey Medical Foundation Family Medicine CurrentSince Jul 23, 2018 Accepting new patients
Providence Facey Medical Foundation CurrentSince Jul 23, 2018 Accepting new patients

Locations

191 S Buena Vista St
Ste 100
Burbank, CA 91505
Phone (818) 869-7600

File 50670
Los Angeles, CA 90074

18460 Roscoe Blvd
Northridge, CA 91325
Phone (818) 734-3600

19950 Rinaldi St
Ste 103
Porter Ranch, CA 91326
Phone (818) 403-2400

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: hhekmatjou926090@oc.providencedirect.org

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1432252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1124407119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9602",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913469602",
            "telephone_number": "818-837-5559",
            "fax_number": "818-792-4793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 S BUENA VISTA ST",
            "address_2": "SUITE 100",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054554",
            "telephone_number": "818-869-7600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEKMATJOU",
        "first_name": "HESAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-22",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A151253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.