Nicky Mahboob Wadiwala, D.O.

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

20A11280 Issued in CA

Practice address

1700 E Cesar E Chavez Ave Ste 1200
Los Angeles, CA 90033-2467

Phone

(323) 268-2200

Fax

(323) 268-2200

NPI assigned

Jun 25, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

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

Specialty

Cardiovascular Disease (Cardiology)Also: Interventional Cardiology

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Boyle Heights Cardiovascular Medical Group Inc.Group PAC ID 2163522525, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tristar Home Health Care, Inc Home health agency, Northridge, CA, CCN 559499
• Adventist Health White Memorial Hospital, Los Angeles, CA, CCN 050103
• Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

95.95

Improvement activities

40

Cost

82

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Boyle Heights Cardiovascular Medical Group Inc

  • Interventional Cardiology Physician
  • Los Angeles, CA
  • NPI 1659498004
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health System - Southern California

  • General Acute Care Hospital
  • Burbank, CA
  • NPI 1336173269
  Care Compare affiliation
• Tristar Home Health Care,Inc.

  • Home Health Agency
  • Northridge, CA
  • NPI 1972161511
  Care Compare affiliation
• White Memorial Medical Center

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1215927470
  Care Compare affiliation

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1494201600000",
    "number": "1255642179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E CESAR E CHAVEZ AVE STE 1200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332467",
            "telephone_number": "323-268-2200",
            "fax_number": "323-268-2212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E CESAR E CHAVEZ AVE STE 1200",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332467",
            "telephone_number": "323-268-2200",
            "fax_number": "323-268-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADIWALA",
        "first_name": "NICKY",
        "middle_name": "MAHBOOB",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-25",
        "last_updated": "2017-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A11280",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "20A11280",
            "primary": true
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "CA",
            "license": "20A11280",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0082854",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H198010",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mitali Wadekar, M.D.
• Peter Schaaff Wadhams, DPM
• Isha Wadhawan, M.D.
• Jasveen Wadia, D.D.S
• Subeer K Wadia, M.D.
• Zerghona Wadood, MD
• Timothy Garth Wadsworth
• Norwan Moaleji Wafa, PHARM.D.
• Stephane Wafer
• Elizabeth Wagar, MD

• Cardiovascular Disease Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Cardiovascular Disease Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.