Active NPI
Mohammad Ali Gharavi, MD
- Vascular Surgery Physician
- Encino, CA
National Provider Identifier
1285602698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- A30200
- Practice address
- 16255 Ventura Blvd
Suite 910
Encino, CA 91436 - Phone
- (818) 990-4600
- NPI assigned
- Mar 10, 2006
- Last updated
- Apr 8, 2008
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | A30200 | CA | Primary |
Addresses
Primary practice location
16255 Ventura Blvd
Suite 910
Encino, CA 91436
Mailing address
2190 Lynn Rd
Suite 220
Thousand Oaks, CA 91360
Phone (805) 495-8050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A302000 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A30200 | CA | MD | Vascular Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| NPI 1033163019 | Past | Accepting new patients | |
| California Center for Cardiothoracic Surgery | Vascular Surgery | Past | Accepting new patients |
| California Center for Cardiothoracic Surgery, a Medical Group | Vascular Surgery | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Vascular Surgery Physician
- Thousand Oaks, CA
- NPI 1316976327
-
- Vascular Surgery Physician
- Encino, CA
- NPI 1588872907
-
- NPI 1033163019
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207612800000",
"number": "1285602698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2190 LYNN RD",
"address_2": "SUITE 220",
"city": "THOUSAND OAKS",
"state": "CA",
"postal_code": "91360",
"telephone_number": "805-495-8050",
"fax_number": "805-496-2160"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16255 VENTURA BLVD",
"address_2": "SUITE 910",
"city": "ENCINO",
"state": "CA",
"postal_code": "91436",
"telephone_number": "818-990-4600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GHARAVI",
"first_name": "MOHAMMAD",
"middle_name": "ALI",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-10",
"last_updated": "2008-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "CA",
"license": "A30200",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A302000",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.