Individual provider Active NPI

Michael Pan

  • Dermatology Physician
  • Beverly Hills, CA
National Provider Identifier
1144607680
Registry record updated Apr 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A161456 Issued in CA
Practice address
99 N la Cienega Blvd Ste 202
Beverly Hills, CA 90211-2285
Phone
(310) 385-3300
NPI assigned
May 5, 2015
Last updated
Apr 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A161456 CA Primary

Addresses

Primary practice location

99 N la Cienega Blvd Ste 202
Beverly Hills, CA 90211-2285

Mailing address

1356 Lusitana St FL 7
Honolulu, HI 96813-2409

Other practice location 1

1356 Lusitana St Fl 7
Honolulu, HI 96813-2409
Phone (808) 586-7477

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20191111002795 CA Practitioner - Dermatology 0042556011 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cedars-Sinai Medical Care FoundationGroup PAC ID 0941106645, 1,684 clinicians

Practice addresses (Care Compare)

99 N la Cienega Blvd
Suite 202
Beverly Hills, CA 90211-2285
Phone (310) 385-3300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.14 of 100Reported as group
Quality
84.79
Promoting interoperability
99
Improvement activities
40
Cost
73.15

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions147
Skin biopsy104

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A161456CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cedars-Sinai Medical Care Foundation CurrentSince Mar 13, 2023 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 8, 2019 Accepting new patients
Southern California Permanente Medical Group CurrentSince Oct 8, 2019 Accepting new patients
Cedars-Sinai Medical Care Foundation CurrentSince Mar 13, 2023 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

99 N La Cienega Blvd
Ste 202
Beverly Hills, CA 90211
Phone (310) 385-3300

4733 W Sunset Blvd
Los Angeles, CA 90027
Phone (213) 667-4784

8635 W 3rd St
Ste 465W
Los Angeles, CA 90048
Phone (310) 423-0674

393 E Walnut St
Pasadena, CA 91188
Phone (626) 405-7914

Interoperability endpoints

  • Direct secure messaging: mpan442123@direct.cshs.org

Organizations & group practices 5

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 2

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": "1430784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1144607680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1356 LUSITANA ST FL 7",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968132409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 N LA CIENEGA BLVD STE 202",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902112285",
            "telephone_number": "310-385-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1356 Lusitana St Fl 7",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968132409",
            "country_code": "US",
            "telephone_number": "808-586-7477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAN",
        "first_name": "MICHAEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-05-05",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A161456",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4733 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Beverly Hills, CA

Sources for this page

Verify at the official NPI Registry.