Individual provider Active NPI

Bahram Jahanbakhsh, M.D.

  • Anesthesiology Physician
  • Staten Island, NY
National Provider Identifier
1164715686
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
279538 Issued in NY
Practice address
475 Seaview Ave
Staten Island, NY 10305-3436
Phone
(718) 226-9292
NPI assigned
May 17, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X 279538 NY
Anesthesiology Physician 207L00000X 279538 NY Primary

Addresses

Primary practice location

475 Seaview Ave
Staten Island, NY 10305-3436

Mailing address

175 Adams St Apt 9H
Brooklyn, NY 11201-1817

Other practice location 1

622 W 168th St
New York, NY 10032-3720
Phone (212) 305-2069

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 NY, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160504001478 NY Practitioner - Pain ManagementPractitioner - Anesthesiology 0941509483 Reassigns benefits to 2 organizations
I20260202000918 CA Practitioner - Anesthesiology 0941509483 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2011
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

393 E Walnut 3Rd FL
Pasedena, CA 91188-0001

393 E Walnut St FL
3 PHR Group Provider Enrollment Unit
Pasadena, CA 91188-0001

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Nov 4, 2025 Accepting new patients
Harlem Medical Associates PC CurrentSince Feb 27, 2019 Accepting new patients
Downtown Bronx Medical Associates PC CurrentSince Mar 1, 2020 Accepting new patients
Southern California Permanente Medical Group CurrentSince Nov 4, 2025 Accepting new patients

Locations

6041 Cadillac Ave
Los Angeles, CA 90034
Phone (323) 857-2000

234 Eugenio Maria de Hosto Blvd
Bronx, NY 10451
Phone (718) 579-5874

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

45 Research Way
Ste 206
Setauket, NY 11733
Phone (631) 575-9300

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1305590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1164715686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 ADAMS ST APT 9H",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112011817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 SEAVIEW AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103053436",
            "telephone_number": "718-226-9292"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "622 W 168th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100323720",
            "country_code": "US",
            "telephone_number": "212-305-2069",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JAHANBAKHSH",
        "first_name": "BAHRAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-17",
        "last_updated": "2024-10-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NY",
            "license": "279538",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NY",
            "license": "279538",
            "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": "6041 Cadillac Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900341702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Staten Island, NY

Sources for this page

Verify at the official NPI Registry.