NPIMap

Individual provider Active NPI

Elham Ghadishah, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Culver City, CA
National Provider Identifier
1174546071
Registry record updated Mar 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
A55006 Issued in CA
Practice address
3831 Hughes Ave
Suite 708
Culver City, CA 90232-2751
Phone
(323) 936-8800
Fax
(310) 441-7739
NPI assigned
Jul 25, 2006
Last updated
Mar 24, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A55006 CA
Geriatric Medicine (Family Medicine) Physician 207QG0300X A55006 CA Primary

Addresses

Primary practice location

3831 Hughes Ave
Suite 708
Culver City, CA 90232-2751

Mailing address

10660 Wilshire Blvd
Suite 1108
Los Angeles, CA 90024-4522
Phone (323) 936-8800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address eghadishah390149@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050815000271 CA Practitioner - Internal MedicinePractitioner - Family PracticePractitioner - Geriatric Medicine 2567492119 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of California, San Diego School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Superior Hospitalist Medical Group IncGroup PAC ID 1456650928, 75 clinicians
Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

1680 E 120TH St
Los Angeles, CA 90059-3026
Phone (424) 338-8000

4101 Torrance Blvd
Torrance, CA 90503-4607
Phone (310) 303-7496

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
55006CAMDDentist
A55006CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centinela Hospitalist Medical Group Inc CurrentSince Oct 1, 2008 Accepting new patients
Providence Medical Institute Family Medicine CurrentSince Dec 1, 2014 Accepting new patients
Providence Medical Institute Family Medicine Current Accepting new patients
Hospitalist Group of Montebello Inc CurrentSince Apr 1, 2024 Accepting new patients
Superior Hospitalist Medical Group Inc Family Medicine CurrentSince Oct 15, 2022 Accepting new patients
Providence Medical Institute Family Medicine CurrentSince Dec 1, 2014 Accepting new patients
Petrel Emergency Physicians, a Medical Corporation PastSince Sep 28, 2015 Accepting new patients
B & G Medical and Surgical Providers a Professional Corporation PastSince Dec 1, 2019 Accepting new patients
Prime Healthcare Centinela, LLC Past Accepting new patients

Locations

21501 Avalon Blvd
Ste 100
Carson, CA 90745
Phone (310) 835-6627

555 E Hardy St
Inglewood, CA 90301
Phone (310) 419-8636

1680 E 120th St
Los Angeles, CA 90059
Phone (424) 338-8000

1300 W 7th St
San Pedro, CA 90732
Phone (310) 514-5350

1499 W 1st St
San Pedro, CA 90732
Phone (310) 241-2590

1701 Santa Anita Ave
South El Monte, CA 91733
Phone (626) 350-7916

4101 Torrance Blvd
Torrance, CA 90503
Phone (310) 540-7676

4650 Lincoln Blvd
Venice, CA 90292
Phone (310) 264-2561

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: eghadishah390149@oc.providencedirect.org

Organizations & group practices 9

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 10

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": "1153785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1648080000000",
    "number": "1174546071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10660 WILSHIRE BLVD",
            "address_2": "SUITE 1108",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900244522",
            "telephone_number": "323-936-8800",
            "fax_number": "310-441-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3831 HUGHES AVE",
            "address_2": "SUITE 708",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322751",
            "telephone_number": "323-936-8800",
            "fax_number": "310-441-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHADISHAH",
        "first_name": "ELHAM",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-25",
        "last_updated": "2022-03-24",
        "certification_date": "2022-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A55006",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A55006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "eghadishah390149@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "1499 W 1st St",
            "city": "San Pedro",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907323255",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

Verify at the official NPI Registry.