Mohammed Sufiyan Kagzi, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

107568 Issued in CA

Practice address

204 Hampton Dr
Venice, CA 90291-2623

Phone

(310) 396-6468

NPI assigned

Jun 27, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA, ID, WA, OR, TX, NM, MT, AK8 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 8

Specialty

Clinical Social Worker

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Swedish Health ServicesGroup PAC ID 0244138196, 1,038 clinicians

Sud Specialty Group - CaGroup PAC ID 9537534177, 519 clinicians

Providence Health and Services WashingtonGroup PAC ID 0345139929, 778 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Sud Specialty Group - Ca

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • Santa Clara, CA
  • NPI 1972138238

  Clinical

  Medicare reassignment Care Compare group NPD
• Providence Health & Services Washington

  • Pulmonary Disease Physician
  • Spokane, WA
  • NPI 1194099390

  CA

  Medicare reassignment Care Compare group NPD
• Swedish Health Services

  • Internal Medicine Physician
  • Seattle, WA
  • NPI 1689612954

  CA, Clinical

  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PC

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1154994846
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  AK, ID, MT, NM, OR, TX, WA

  Medicare reassignment NPD
• Providence Health & Services - Washington

  • Family Medicine Physician
  • Walla Walla, WA
  • NPI 1922259738

  CA, Clinical

  Medicare reassignment NPD
• Providence Health & Services Washington

  • Family Medicine Physician
  • Olympia, WA
  • NPI 1174744304

  CA, Clinical

  Medicare reassignment NPD
• Providence Health & Services- Washington

  • Critical Care Medicine (Internal Medicine) Physician
  • Anchorage, AK
  • NPI 1093956278

  CA, Clinical

  Medicare reassignment NPD
• Providence Health & Services- Washington

  • General Practice Physician
  • Everett, WA
  • NPI 1124270715

  CA, Clinical

  Medicare reassignment NPD
• Apex Therapy Group, a Marriage and Family Therapy Corporation

  • Marriage & Family Therapist
  • Sherman Oaks, CA
  • NPI 1346838422

  Clinical

  NPD (past)

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

{
    "created_epoch": "1530057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728950400000",
    "number": "1366937757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4153 MILTON AVE",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902324054",
            "telephone_number": "310-954-7569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 HAMPTON DR",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902912623",
            "telephone_number": "310-396-6468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAGZI",
        "first_name": "MOHAMMED",
        "middle_name": "SUFIYAN",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-27",
        "last_updated": "2024-10-15",
        "certification_date": "2022-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "84502",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "107568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "6041 Cadillac Ave",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900341702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Karen W. Jenne, N.P.
• Hongyun Jin, O.M.D.
• John William Johnson, LMFT
• Paul Jones
• Sarah Juul, DPT
• Fred Kahane, M.F.T.
• Kaiser Permanente
• Athanasia Nancy Kakoyannis, D.O.
• Leonard Kalina, ACUPUNCTURIST
• Melissa Renee Kallsen, L.AC

• Clinical Social Worker in Venice, CA
• Providers in Venice, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2024; 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.

Verify at the official NPI Registry.