Individual provider Active NPI

Jonah Agra

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1124737903
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA62419 Issued in CA
Practice address
2110 W Sunset Blvd Ste M
Los Angeles, CA 90026-7318
Phone
(833) 873-2852
NPI assigned
Nov 21, 2022
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA62419 CA Primary

Addresses

Primary practice location

2110 W Sunset Blvd Ste M
Los Angeles, CA 90026-7318

Mailing address

2801 Sunset PL Apt 1925
Los Angeles, CA 90005-4529

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241204000607 CA Practitioner - Physician Assistant 9234665068 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13365 W Washington Blvd
Los Angeles, CA 90066-5134
Phone (310) 504-1825

2110 W Sunset Blvd
Suite M
Los Angeles, CA 90026-7318
Phone (833) 873-2852

4700 W Pico Blvd
Suite G 5
Los Angeles, CA 90019-4267
Phone (323) 840-1343

858 N Rose Dr
Suite C 2
Placentia, CA 92870-7522
Phone (714) 792-3736

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA62419CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carbon Health Medical Group of California PC CurrentSince Nov 26, 2024 Accepting new patients

Locations

7330 El Camino Real
Atascadero, CA 93422
Phone (805) 703-2501

2110 W Sunset Blvd
Ste M
Los Angeles, CA 90026
Phone (510) 686-3621

2944 Tapo Canyon Rd
Ste A
Simi Valley, CA 93063
Phone (805) 306-5990

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.

NPI Registry JSON

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

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1124737903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 SUNSET PL APT 1925",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900054529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2110 W SUNSET BLVD STE M",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900267318",
            "telephone_number": "833-873-2852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGRA",
        "first_name": "JONAH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-21",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA62419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.