NPIMap

Individual provider Active NPI

Vimal J Ponnezhan, MD

  • Pulmonary Disease Physician
  • Los Angeles, CA
National Provider Identifier
1366653354
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
A116214 Issued in CA
Practice address
4081 E Olympic Blvd
Los Angeles, CA 90023-3330
Phone
(323) 267-0477
NPI assigned
May 24, 2007
Last updated
Aug 24, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301087977 MI
Pulmonary Disease Physician 207RP1001X A116214 CA Primary

Addresses

Primary practice location

4081 E Olympic Blvd
Los Angeles, CA 90023-3330

Mailing address

3579 E Foothill Blvd Ste 432
Pasadena, CA 91107-3119
Phone (310) 422-3000

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
I20140806002731 CA Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists)Practitioner - Hospitalist 0941348254 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

3630 E Imperial Hwy
Lynwood, CA 90262-2609
Phone (310) 900-8900

959 E Walnut St
Suite 120
Pasadena, CA 91106-5364
Phone (626) 795-5118

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue65

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301087977MIMDInternal Medicine Physician
A116214CAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Prohealth Partners, a Medical Group Multi-Specialty Current Accepting new patients
Foothill Pulmonary & Critical Care Consultants Medical Group Inc. Multi-Specialty CurrentSince Jul 1, 2022 Accepting new patients
American Critical Care Consultants Corporation Multi-Specialty CurrentSince Jul 1, 2022 Accepting new patients
Prohealth Partners a Medical Group Multi-Specialty CurrentSince Aug 1, 2015 Accepting new patients
Prohealth Partners, a Medical Group, Inc. Multi-Specialty CurrentSince Aug 1, 2015 Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
UCSF Health Community Hospitals Past Accepting new patients
Prohealth Partners, a Medical Group, Inc. Multi-Specialty Past Accepting new patients
Ahmc Garfield Medical Center LP Past Accepting new patients
Prohealth Medical Group Inc Multi-Specialty Past Accepting new patients

Locations

1812 Verdugo Blvd
Glendale, CA 91208
Phone (818) 246-8000

3700 South St
Lakewood, CA 90712
Phone (562) 424-2900

3801 Katella Ave
Ste 330
Los Alamitos, CA 90720
Phone (562) 594-9546

4081 E Olympic Blvd
Los Angeles, CA 90023
Phone (323) 267-0477

File 54567
Los Angeles, CA 90074
Phone (310) 491-9060

3630 E Imperial Hwy
Lynwood, CA 90262
Phone (310) 900-7420

3579 E Foothill Blvd
Pasadena, CA 91107
Phone (310) 497-8274

959 E Walnut St
Ste 120
Pasadena, CA 91106
Phone (626) 795-1831

4201 Torrance Blvd
Ste 350
Torrance, CA 90503
Phone (310) 540-5494

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 10

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 9

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": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1366653354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3579 E FOOTHILL BLVD STE 432",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911073119",
            "telephone_number": "310-422-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4081 E OLYMPIC BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900233330",
            "telephone_number": "323-267-0477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PONNEZHAN",
        "first_name": "VIMAL",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301087977",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "A116214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.