Individual provider Active NPI

Priya Pillutla, M.D.

  • Adult Congenital Heart Disease Physician
  • Los Angeles, CA
National Provider Identifier
1255453171
Registry record updated Oct 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Congenital Heart Disease PhysicianTaxonomy code 207RA0002X
License
A94291 Issued in CA
Practice address
100 Medical PLZ
Ste. 630
Los Angeles, CA 90095-0001
Phone
(310) 825-9011
Fax
(310) 825-6346
NPI assigned
Apr 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Congenital Heart Disease Physician 207RA0002X A94291 CA Primary

Addresses

Primary practice location

100 Medical PLZ
Ste. 630
Los Angeles, CA 90095-0001

Mailing address

Center for the Health Sciences Room A2 237
650 Charles E. Young Drive South
Los Angeles, CA 90095-0001
Phone (310) 825-2019

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
I20120508000097 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 5890957989 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
New York University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
County of Los AngelesGroup PAC ID 1850296534, shared by 7 NPIs, 395 clinicians

Practice addresses (Care Compare)

12021 S Wilmington Ave
Room 1059
Los Angeles, CA 90059-3019

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A94291CAMDAdult Congenital Heart Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Apr 1, 2012 Accepting new patients
County of Los Angeles CurrentSince Nov 25, 2020 Accepting new patients
County of Los Angeles CurrentSince Apr 1, 2012 Accepting new patients

Locations

1000 S Fremont Ave
Bldg A11
Alhambra, CA 91803
Phone (626) 457-4240

1000 S Fremont Ave
Unit 9
Alhambra, CA 91803

1670 E 120th St
Los Angeles, CA 90059
Phone (424) 338-1000

1000 W Carson St
Torrance, CA 90502
Phone (310) 222-3501

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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 1

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": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1255453171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "CENTER FOR THE HEALTH SCIENCES ROOM A2 237",
            "address_2": "650 CHARLES E. YOUNG DRIVE SOUTH",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-825-2019",
            "fax_number": "310-825-6346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PLZ",
            "address_2": "STE. 630",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900950001",
            "telephone_number": "310-825-9011",
            "fax_number": "310-825-6346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PILLUTLA",
        "first_name": "PRIYA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-03",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RA0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adult Congenital Heart Disease",
            "state": "CA",
            "license": "A94291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.