NPIMap

Individual provider Active NPI

Amin Khorsandi, M.D.

  • Internal Medicine Physician
  • Santa Monica, CA
National Provider Identifier
1275547390
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A56357 Issued in CA
Practice address
2222 Santa Monica Blvd
Suite 301
Santa Monica, CA 90404-2304
Phone
(310) 449-0093
Fax
(310) 449-9204
NPI assigned
Jul 27, 2006
Last updated
Jul 9, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A56357 CA Primary

Addresses

Primary practice location

2222 Santa Monica Blvd
Suite 301
Santa Monica, CA 90404-2304

Mailing address

2222 Santa Monica Blvd
Suite 301
Santa Monica, CA 90404-2304
Phone (310) 449-0093

Other identifiers 1

IdentifierTypeStateIssuer
00A563570MedicaidCA

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
I20090813000348 CA Practitioner - Internal Medicine 6800969957 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

2222 Santa Monica Blvd
Suite 301
Santa Monica, CA 90404-2307
Phone (310) 449-0093

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A56357CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wilbur Imaging Partners Inc Current Accepting new patients
Providence Saint John's Health Center Past Accepting new patients
Prime Healthcare Centinela, LLC Past Accepting new patients
The Regents of the University of California Past Accepting new patients

Locations

6742 Winnetka Ave
Winnetka, CA 91306
Phone (818) 705-3200

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Five Star Home Health, Inc.Los Angeles, CA, CCN 058215 Home health agency Contracted Managing Employee (1%) Jul 1, 2018

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 5

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": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1275547390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2222 SANTA MONICA BLVD",
            "address_2": "SUITE 301",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042304",
            "telephone_number": "310-449-0093",
            "fax_number": "310-449-9204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 SANTA MONICA BLVD",
            "address_2": "SUITE 301",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042304",
            "telephone_number": "310-449-0093",
            "fax_number": "310-449-9204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHORSANDI",
        "first_name": "AMIN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A56357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A563570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.