Maria Jan, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A131530 Issued in CA

Practice address

29525 Canwood St Ste 300
Agoura Hills, CA 91301-4232

Phone

(818) 706-2477

Fax

(818) 706-2368

NPI assigned

Apr 19, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Maria Ikhlas Former name

Electronic endpoints 1

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

Internal Medicine

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Providence Medical InstituteGroup PAC ID 5991609737, 303 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Adventist Health Simi Valley Hospital, Simi Valley, CA, CCN 050236
• UCLA West Valley Medical Center Hospital, West Hills, CA, CCN 050481
• Northridge Hospital Medical Center Hospital, Northridge, CA, CCN 050116

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1417915760

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1235182569

  Internal Medicine

  NPD
• Providence Medical Institute

  • Family Medicine Physician
  • Torrance, CA
  • NPI 1760425862

  Internal Medicine

  NPD
• West Hills Hospital

  • General Acute Care Hospital
  • West Hills, CA
  • NPI 1023065729
  NPD (past)

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

• Dignity Community Care

  • General Acute Care Hospital
  • Northridge, CA
  • NPI 1417089350
  Care Compare affiliation
• Regents Univ of Calif Los Angeles

  • General Acute Care Hospital
  • West Hills, CA
  • NPI 1801653969
  Care Compare affiliation
• Simi Valley Hospital and Health Care Services

  • General Acute Care Hospital
  • Simi Valley, CA
  • NPI 1063495190
  Care Compare affiliation

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

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618444800000",
    "number": "1306136718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST STE 300",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014232",
            "telephone_number": "818-706-2477",
            "fax_number": "818-706-2368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29525 CANWOOD ST STE 300",
            "city": "AGOURA HILLS",
            "state": "CA",
            "postal_code": "913014232",
            "telephone_number": "818-706-2477",
            "fax_number": "818-706-2368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAN",
        "first_name": "MARIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-04-19",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A131530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjan457188@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "29525 Canwood St Ste 300",
            "city": "Agoura Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913014232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARIA",
            "last_name": "IKHLAS",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James Thomas Iwanoff, D.C.
• Jack M. Gindi, M.D. a Medical Corporation
• Jaime Elizabeth Medvene PHD a Professional Psychological Corpora
• Aryan Jamali
• James F. Mulick, DDS, Inc
• Jeremy S. Bass, M.D., a Medical Corporation
• Jerold T. Litoff, a Professional Corp.
• Jie Ji
• Tracy Still Jimenez, M.P.H., R.D.
• Joelle Abed Elahad Dental Corp

• Internal Medicine Physician in Agoura Hills, CA
• Providers in Agoura Hills, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2021; 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.