Active NPI
Reza Khorsan, M.D.
- Nephrology Physician
- Santa Monica, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- A101659
- Practice address
- 1245 16TH St Ste 309
Santa Monica, CA 90404-1239 - Phone
- (310) 319-4371
- Fax
- (310) 319-4141
- NPI assigned
- Sep 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | A101659 | CA | Primary |
| Internal Medicine Physician | 207R00000X | A101659 | CA |
Addresses
Primary practice location
1245 16TH St Ste 309
Santa Monica, CA 90404-1239
Mailing address
1245 16TH St Ste 309
Santa Monica, CA 90404-1239
Phone (310) 319-4371
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356536585 | Medicaid | CA |
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: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nephrology
- Education
- Ohio State University College of Medicine, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
100 Medical Plaza
Los Angeles, CA 90095-0001
100 Medical PLZ
Suite 310
Los Angeles, CA 90095-0001
Phone (310) 825-7922
1245 16TH St
Santa Monica, CA 90404-1240
200 Medical Plaza
Los Angeles, CA 90095-0001
200 Medical PLZ
Los Angeles, CA 90095-0001
200 UCLA Medical PLZ
Suite 165 34
Los Angeles, CA 90095-0001
Phone (310) 824-8403
2020 Santa Monica Blvd
Suite 210
Santa Monica, CA 90404-2139
Phone (310) 458-2381
757 Westwood PLZ
Los Angeles, CA 90095-8358
Phone (310) 267-9643
900 Weyburn Place
Suite 14 171
Los Angeles, CA 90095-0001
Phone (310) 825-8173
Hospital & facility affiliations
- DaVita Santa Monica Dialysis
- DaVita Brentwood Home Training
- Santa Monica - UCLA Med Ctr & Orthopaedic Hospital
- Ronald Reagan UCLA Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A101659 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Regents of the University of California | Internal Medicine | Current | Accepting new patients |
| County of Los Angeles | Current | Accepting new patients | |
| The Regents of the University of California | Current | Accepting new patients | |
| County of Los Angeles | Current | Accepting new patients | |
| Regents Univ of Calif Los Angeles | Past | Accepting new patients | |
| The Regents of the University of California | Past | Accepting new patients | |
| UCLA Medical Group | Internal Medicine | Past | Accepting new patients |
Locations
100 UCLA Medical Plz
Ste 690
Los Angeles, CA 90024
Phone (310) 206-2235
5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200
File 55737
Los Angeles, CA 90074
2020 Santa Monica Blvd
Ste 210
Santa Monica, CA 90404
Phone (310) 458-2381
1245 16th St
Ste 309
Santa Monica, CA 90404
Phone (310) 319-4377
1245 16th St
Ste 307
Santa Monica, CA 90404
Phone (310) 481-4228
14445 Olive View Dr
Sylmar, CA 91342
Phone (881) 836-4303
Interoperability endpoints
- rkhorsan37899@direct.uclahealth.org
Organizations & group practices 7
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.
-
- Internal Medicine Physician
- Los Angeles, CA
- NPI 1235107566
-
- General Acute Care Hospital
- Torrance, CA
- NPI 1851363188
-
- Clinic/Center
- Los Angeles, CA
- NPI 1295407401
-
- Ambulatory Surgical Clinic/Center
- Valencia, CA
- NPI 1689200305
-
- Psychiatric Hospital
- Los Angeles, CA
- NPI 1952308363
-
- General Acute Care Hospital
- Santa Monica, CA
- NPI 1982849105
-
- Internal Medicine Physician
- Los Angeles, CA
- NPI 1043427248
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Santa Monica, CA
- NPI 1144295163
Dialysis facility
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Los Angeles, CA
- NPI 1902377591
Dialysis facility
-
- General Acute Care Hospital
- Santa Monica, CA
- NPI 1427055839
-
- General Acute Care Hospital
- Los Angeles, CA
- NPI 1902803315
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1189468800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1315785600000",
"number": "1356536585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1245 16TH ST STE 309",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904041239",
"telephone_number": "310-319-4371",
"fax_number": "310-319-4141"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1245 16TH ST STE 309",
"city": "SANTA MONICA",
"state": "CA",
"postal_code": "904041239",
"telephone_number": "310-319-4371",
"fax_number": "310-319-4141"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHORSAN",
"first_name": "REZA",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-09-11",
"last_updated": "2011-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "A101659",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "A101659",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1356536585",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Santa Monica, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2011; 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.