NPIMap

Individual provider Active NPI

Ezzat A Nashed, MD

  • Family Medicine Physician
  • Victorville, CA
National Provider Identifier
1336106640
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A48771 Issued in CA
Practice address
16200 Bear Valley Rd
Ste 102
Victorville, CA 92395-8764
Phone
(760) 962-0077
Fax
(760) 967-1098
NPI assigned
Apr 28, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A48771 CA Primary

Addresses

Primary practice location

16200 Bear Valley Rd
Ste 102
Victorville, CA 92395-8764

Mailing address

16200 Bear Valley Rd
Ste 102
Victorville, CA 92395-8764
Phone (760) 962-0077

Other identifiers 2

IdentifierTypeStateIssuer
00A487713MedicaidCA
A48771OtherLIC #

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
I20060410000661 CA Practitioner - Internal Medicine 8628087244 Practice locations: Victorville, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

16200 Bear Valley Rd
Suite 102
Victorville, CA 92395-8764
Phone (760) 962-0077

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary Medical Center Past Accepting new patients
Desert Valley Hospital, LLC Past Accepting new patients
Victor Valley Community Hospital Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: ezzatnashed@nashedclinic.directglo.com

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1336106640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16200 BEAR VALLEY RD",
            "address_2": "STE 102",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923958764",
            "telephone_number": "760-962-0077",
            "fax_number": "760-967-1098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16200 BEAR VALLEY RD",
            "address_2": "STE 102",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923958764",
            "telephone_number": "760-962-0077",
            "fax_number": "760-967-1098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASHED",
        "first_name": "EZZAT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A48771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A487713",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LIC #",
            "identifier": "A48771",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.