NPIMap

Individual provider Active NPI

Raffi R Minasian, MD

  • Nephrology Physician
  • Glendale, CA
National Provider Identifier
1306860465
Registry record updated Nov 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G52887 Issued in CA
Practice address
1500 S Central Ave
Suite300
Glendale, CA 91204-2530
Phone
(818) 242-0475
Fax
(818) 662-0260
NPI assigned
Jul 26, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X G52887 CA Primary

Addresses

Primary practice location

1500 S Central Ave
Suite300
Glendale, CA 91204-2530

Mailing address

1500 S Central Ave
Suite300
Glendale, CA 91204-2530
Phone (818) 242-0475

Other identifiers 1

IdentifierTypeStateIssuer
00G528870MedicaidCA

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
I20061108000458 CA Practitioner - NephrologyPractitioner - Internal Medicine 9739125790 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Southern California Keck School of Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Disease Medical Group Inc 8 clinicians

Practice addresses (Care Compare)

1505 Wilson Ter
Suite 155
Glendale, CA 91206-4032
Phone (818) 500-4055

Hospital & facility affiliations

  • Home Dialysis Centers of Rancho Cucamonga Dialysis facility, Rancho Cucamonga, CA, CCN 552675
  • Quotidian Home Dialysis Clinic Dialysis facility, La Habra, CA, CCN 552590
  • DaVita Baldwin Park Dialysis facility, Baldwin Park, CA, CCN 552889
  • DaVita West Glendale Dialysis Dialysis facility, Glendale, CA, CCN 052859
  • FMC Dialysis Services of West Covina Dialysis facility, West Covina, CA, CCN 052847
  • Panacea Group, Inc Home health agency, Glendale, CA, CCN 059437
  • Glendale Adventist Medical Center Hospital, Glendale, CA, CCN 050239
  • Usc Verdugo Hills Hospital Hospital, Glendale, CA, CCN 050124
  • Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382
  • Glendale Mem Hospital & HLTH Center Hospital, Glendale, CA, CCN 050058
  • Northridge Hospital Medical Center Hospital, Northridge, CA, CCN 050116

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G52887CAMDNephrology Physician

Practice roles (8 of 9)

OrganizationSpecialtyStatusNew patients
Kidney Disease Medical Group Inc CurrentSince Jan 1, 2015 Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Cha Hollywood Medical Center, LP Past Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients
Glendale Nephrology Services, LLC PastSince Sep 10, 1999 Accepting new patients

Locations

44 N Tu Su Ln
Bishop, CA 93514
Phone (760) 873-6111

1505 Wilson Ter
Ste 155
Glendale, CA 91206
Phone (818) 500-4055

1500 S Central Ave
Ste 300
Glendale, CA 91204
Phone (818) 242-0475

1500 S Central Ave
Ste 221
Glendale, CA 91204
Phone (818) 242-0475

1540 W West Covina Pkwy
#102
West Covina, CA 91790

1540 W West Covina Pkwy
West Covina, CA 91790
Phone (626) 337-8007

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: raffi.minasian.1@15679.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15679/brand/1/csg/1/fhir/r4

Organizations & group practices 8

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480291200000",
    "number": "1306860465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S CENTRAL AVE",
            "address_2": "SUITE300",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042530",
            "telephone_number": "818-242-0475",
            "fax_number": "818-662-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S CENTRAL AVE",
            "address_2": "SUITE300",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042530",
            "telephone_number": "818-242-0475",
            "fax_number": "818-662-0260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINASIAN",
        "first_name": "RAFFI",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2016-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G52887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G528870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.