NPIMap

Individual provider Active NPI

Hassan Boroujerdi-Rad, MD

  • Nephrology Physician
  • Whittier, CA
National Provider Identifier
1205814837
Registry record updated Jul 10, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A55053 Issued in CA
Practice address
14350 East Whittier Blvd,
101
Whittier, CA 90605-2138
Phone
(562) 907-7616
Fax
(562) 907-7615
NPI assigned
Jan 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A55053 CA Primary

Addresses

Primary practice location

14350 East Whittier Blvd,
101
Whittier, CA 90605-2138

Mailing address

14350 East Whittier Blvd
101
Whittier, CA 90605-2138
Phone (562) 907-7616

Other identifiers 1

IdentifierTypeStateIssuer
00A550530MedicaidCA

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
I20040319001400 CA Practitioner - NephrologyPractitioner - Internal Medicine 2365332665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12462 Putnam St
Suite 506
Whittier, CA 90602-1049
Phone (562) 698-8141

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A55053CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Whittier Internal Medicine and Nephrology Medical Group Inc Nephrology CurrentSince Jan 1, 2021 Accepting new patients
University of California Irvine Past Accepting new patients
Whittier Kidney Dialysis Center PastSince Jan 22, 2001 Accepting new patients
Pih Health Whittier Hospital Past Accepting new patients
Pih Health Downey Hospital Past Accepting new patients
Ahmc Whittier Hospital Medical Center LP Past Accepting new patients

Locations

1770 W La Habra Blvd
La Habra, CA 90631
Phone (562) 691-8810

9080 Colima Rd
Whittier, CA 90605
Phone (562) 907-1565

14350 Whittier Blvd
Ste 101
Whittier, CA 90605
Phone (562) 907-7616

12462 Putnam St
Ste 506
Whittier, CA 90602
Phone (562) 698-8141

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 6

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 4

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": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247184000000",
    "number": "1205814837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14350 EAST WHITTIER BLVD",
            "address_2": "101",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906052138",
            "telephone_number": "562-907-7616",
            "fax_number": "562-907-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14350 EAST WHITTIER BLVD,",
            "address_2": "101",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906052138",
            "telephone_number": "562-907-7616",
            "fax_number": "562-907-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOROUJERDI-RAD",
        "first_name": "HASSAN",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2009-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A55053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A550530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Whittier, CA

Sources for this page

Verify at the official NPI Registry.