Individual provider Active NPI

Macy Javaherifar

  • Physician Assistant
  • Tarzana, CA
National Provider Identifier
1295563203
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
5143 Lindley Ave
Tarzana, CA 91356-4349
Phone
(310) 651-1901
NPI assigned
Jul 22, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

5143 Lindley Ave
Tarzana, CA 91356-4349

Mailing address

5143 Lindley Ave
Tarzana, CA 91356-4349
Phone (310) 651-1901

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250110001335 CA Practitioner - Physician Assistant 8527596162 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Shine MMG IncGroup PAC ID 6103257282, 25 clinicians
California Mobile Medical Group IncGroup PAC ID 7719330091, 16 clinicians
Aande Medical Group-a Professional Nursing CorporationGroup PAC ID 7719388230, 20 clinicians

Practice addresses (Care Compare)

130 N Brand Blvd
Suite 204
Glendale, CA 91203-2617
Phone (818) 745-0070

130 N Brand Blvd
Suite 208
Glendale, CA 91203-2627
Phone (818) 945-6003

600 N Brand Blvd
Suite 612
Glendale, CA 91203-4214
Phone (818) 239-9293

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1721606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721606400000",
    "number": "1295563203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5143 LINDLEY AVE",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564349",
            "telephone_number": "310-651-1901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5143 LINDLEY AVE",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564349",
            "telephone_number": "310-651-1901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAVAHERIFAR",
        "first_name": "MACY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-22",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tarzana, CA

Sources for this page

Verify at the official NPI Registry.