Retina Los Angeles

Primary specialty

Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X

Legal business name

RETINA LOS ANGELES

Practice address

5400 Balboa Blvd Ste 126
Encino, CA 91316-5202

Phone

(818) 578-0004

Fax

(818) 578-0002

NPI assigned

Oct 13, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Stavros N. Moysidis, M.D.NPI 1780023929

Title

Partner / Physician

Phone

(818) 578-0004

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Interoperability endpoints

• Direct secure messaging: nkoulisis@retinala.intellechartdirect.net
• Direct secure messaging: smoysidis@retinala.intellechartdirect.net

Practitioners 2

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

• Stavros N. Moysidis, M.D.

  • Retina Specialist (Ophthalmology) Physician
  • Encino, CA
  • NPI 1780023929
  Medicare reassignment Care Compare group NPD Authorized official
• Nicole Koulisis, MD

  • Retina Specialist (Ophthalmology) Physician
  • Encino, CA
  • NPI 1073033213
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1665619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1134845837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5400 BALBOA BLVD STE 126",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165202",
            "telephone_number": "818-578-0004",
            "fax_number": "818-578-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 BALBOA BLVD STE 126",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "913165202",
            "telephone_number": "818-578-0004",
            "fax_number": "818-578-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA LOS ANGELES",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-13",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A",
        "authorized_official_last_name": "MOYSIDIS",
        "authorized_official_first_name": "STAVROS",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PARTNER / PHYSICIAN",
        "authorized_official_telephone_number": "818-578-0004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "patients@retinalosangeles.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5400 Balboa Blvd Ste 126",
            "city": "Encino",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913165202",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.RetinaLosAngeles.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "5400 Balboa Blvd Ste 126",
            "city": "Encino",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913165202",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Renova Home Health Inc
• Veronica Resendiz
• Restore Medical
• Restore Medical Group, a Professional Corporation
• Retina Institute of California Medical Group
• Revivacare Mobile
• Revupmd
• Steve Reyes
• Emmanuel Nicolas Reyna
• Ashinee Reynolds

• Retina Specialist (Ophthalmology) Physician in Encino, CA
• Providers in Encino, CA by specialty
• Retina Specialist (Ophthalmology) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; 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.