Individual provider Active NPI

Lena Avedissian, MD

  • Cardiovascular Disease Physician
  • Placerville, CA
National Provider Identifier
1215985494
Registry record updated Mar 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
C140632 Issued in CA
Practice address
1004 Fowler Way
Suite 4
Placerville, CA 95667-5746
Phone
(530) 626-9488
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X C140632 CA Primary

Addresses

Primary practice location

1004 Fowler Way
Suite 4
Placerville, CA 95667-5746

Mailing address

PO Box 45680
San Francisco, CA 94145-0680
Phone (530) 626-2787

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
I20160427001055 CA Practitioner - Cardiovascular Disease (Cardiology) 8729226618 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Boston University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marshall Medical CenterGroup PAC ID 7517875859, 168 clinicians

Practice addresses (Care Compare)

1004 Fowler Way
Suite 4
Placerville, CA 95667-5746
Phone (530) 626-9488

Hospital & facility affiliations

  • Marshall Medical Center Hospital, Placerville, CA, CCN 050254
  • Sutter Medical Center, Sacramento Hospital, Sacramento, CA, CCN 050108

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C140632CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marshall Medical Center CurrentSince May 1, 2016 Accepting new patients
Marshall Medical Center Cardiovascular Disease CurrentSince May 1, 2016 Accepting new patients
Marshall Medical Center Cardiovascular Disease Past Accepting new patients
Marshall Medical Center Cardiovascular Disease Past Accepting new patients

Locations

3501 Palmer Dr
Ste 204
Cameron Park, CA 95682
Phone (530) 626-9488

3581 Palmer Dr
Ste 602
Cameron Park, CA 95682
Phone (530) 626-2920

4201 Town Center Blvd
Bldg D
El Dorado Hills, CA 95762
Phone (530) 344-5400

1004 Fowler Way
Ste 4
Placerville, CA 95667
Phone (530) 626-9488

Organizations & group practices 4

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.

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": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490659200000",
    "number": "1215985494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 45680",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941450680",
            "telephone_number": "530-626-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 FOWLER WAY",
            "address_2": "SUITE 4",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956675746",
            "telephone_number": "530-626-9488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AVEDISSIAN",
        "first_name": "LENA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2017-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "C140632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Placerville, CA

Sources for this page

Verify at the official NPI Registry.