NPIMap

Individual provider Active NPI

Ali Hadadz, MD

  • General Practice Physician
  • Marina del Rey, CA
National Provider Identifier
1316970866
Registry record updated Mar 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A69816 Issued in CA
Practice address
4560 Admiralty Way Ste 303
Marina del Rey, CA 90292-5426
Phone
(310) 204-5510
Fax
(424) 384-5053
NPI assigned
Jul 8, 2006
Last updated
Mar 2, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 2, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A69816 CA Primary

Addresses

Primary practice location

4560 Admiralty Way Ste 303
Marina del Rey, CA 90292-5426

Mailing address

4560 Admiralty Way Ste 303
Marina del Rey, CA 90292-5426
Phone (310) 204-5510

Other identifiers 3

IdentifierTypeStateIssuer
010066259OtherCAMEDICARE RAILROAD
ZZZ05665ZOtherCABLUE SHIELD CA
00A698160MedicaidCA

Other names 1

  • Dr. Ali Haddadzadeh Former name

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
I20090820000238 CA Practitioner - General Practice 6204980527 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beverly Hills Medical CorporationGroup PAC ID 5294889515, 3 clinicians

Practice addresses (Care Compare)

4560 Admiralty Way
Suite 303
Marina del Rey, CA 90292-5426
Phone (310) 274-5510

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A69816CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Luxury Skin Care Med Spa Inc General Practice Current Accepting new patients
Beverly Hills Medical Corporation General Practice CurrentSince Sep 4, 2002 Accepting new patients
Deanco Healthcare LLC. Past Accepting new patients
Mednik Medical Corporation Past Accepting new patients
24-7 Quality Infusion & Home Health Inc PastSince Jun 1, 2011 Accepting new patients
Southern California Healthcare System, Inc Past Accepting new patients
Brotman Medical Center, Inc. Past Accepting new patients
Cedars-Sinai Marina Hospital Past Accepting new patients

Locations

9808 Venice Blvd
Ste 503
Culver City, CA 90232
Phone (310) 204-5510

4560 Admiralty Way
Ste 303
Marina del Rey, CA 90292
Phone (310) 204-5510

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Alden Terrace Convalescent HospitalLos Angeles, CA, CCN 056237 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Aug 22, 2012
Aug 22, 2012
St Andrews HealthcareLos Angeles, CA, CCN 555218 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 May 4, 2026
May 4, 2026
The Rehabilitation Center on PicoLos Angeles, CA, CCN 056377 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2024
Mar 20, 2025

Owned or controlled facilities with NPI records 3

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519948800000",
    "number": "1316970866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4560 ADMIRALTY WAY STE 303",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925426",
            "telephone_number": "310-204-5510",
            "fax_number": "424-384-5053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4560 ADMIRALTY WAY STE 303",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902925426",
            "telephone_number": "310-204-5510",
            "fax_number": "424-384-5053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADADZ",
        "first_name": "ALI",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-08",
        "last_updated": "2018-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A69816",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "010066259",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD CA",
            "identifier": "ZZZ05665Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A698160",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALI",
            "last_name": "HADDADZADEH",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Marina del Rey, CA

Sources for this page

Verify at the official NPI Registry.