NPIMap

Individual provider Active NPI

Khosrow Mahdavi, MD

  • Hematology & Oncology Physician
  • Costa Mesa, CA
National Provider Identifier
1275536773
Registry record updated Nov 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
A33589 Issued in CA
Practice address
1640 Newport Blvd Ste 400
Costa Mesa, CA 92627-3786
Phone
(949) 999-2400
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Internal Medicine) Physician 207RH0000X A33589 CA
Specialist 174400000X A33589 CA
Medical Oncology Physician 207RX0202X A33589 CA
Hematology & Oncology Physician 207RH0003X A33589 CA Primary

Addresses

Primary practice location

1640 Newport Blvd Ste 400
Costa Mesa, CA 92627-3786

Mailing address

200 S Manchester Ave Ste 300
Orange, CA 92868-3219
Phone (714) 456-2986

Other practice location 1

520 Superior Ave
#315
Newport Beach, CA 92663-3637
Phone (949) 642-8566

Other identifiers 1

IdentifierTypeStateIssuer
A33589OtherCALICENSE NUMBER

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
I20060113000958 CA Practitioner - Internal MedicinePractitioner - HematologyPractitioner - Hematology/OncologyPractitioner - Medical Oncology 2062435506 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Hematology, Medical Oncology
Education
Other, 1969
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
UC RegentsGroup PAC ID 7416869516, 316 clinicians

Practice addresses (Care Compare)

101 The City Dr S
Orange, CA 92868-3201

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as apm
Quality
83.7
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A33589CAMDMedical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents CurrentSince Feb 20, 2015 Accepting new patients
UC Regents Current Accepting new patients
University of California Irvine CurrentSince May 1, 2015 Accepting new patients
UC Regents Hematology & Oncology CurrentSince Feb 20, 2015 Accepting new patients
University of California Irvine Current Accepting new patients
UC Irvine Health Cancer Center, Newport Pacific Medical Center CurrentSince May 1, 2015 Accepting new patients
University of California Irvine Past Accepting new patients
UC Regents Past Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients
University of California Irvine Past Accepting new patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients

Locations

1640 Newport Blvd
Ste 400
Costa Mesa, CA 92627
Phone (949) 999-2400

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

200 S Manchester Ave
Ste 300
Orange, CA 92868
Phone (714) 424-9001

101 The City Dr S
Bldg 23
Orange, CA 92868
Phone (714) 456-5889

800 N Main St
Santa Ana, CA 92701
Phone (714) 456-6324

Organizations & group practices 11

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 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": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700006400000",
    "number": "1275536773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 S MANCHESTER AVE STE 300",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683219",
            "telephone_number": "714-456-2986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 NEWPORT BLVD STE 400",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926273786",
            "telephone_number": "949-999-2400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 Superior Ave",
            "address_2": "#315",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926633637",
            "country_code": "US",
            "telephone_number": "949-642-8566",
            "fax_number": "866-235-0746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAHDAVI",
        "first_name": "KHOSROW",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology",
            "state": "CA",
            "license": "A33589",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A33589",
            "primary": false
        },
        {
            "code": "207RX0202X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Medical Oncology",
            "state": "CA",
            "license": "A33589",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "CA",
            "license": "A33589",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A33589",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.