Individual provider Active NPI

Joseph Zikry, M.D.

  • Dermatology Physician
  • Santa Monica, CA
National Provider Identifier
1366978918
Registry record updated Mar 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A159681 Issued in CA
Practice address
1811 Wilshire Blvd Ste 110
Santa Monica, CA 90403-5626
Phone
(310) 829-0260
NPI assigned
May 2, 2017
Reactivated
Jun 27, 2018
Last updated
Mar 23, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Dermatology Physician 207N00000X A159681 CA Primary

Addresses

Primary practice location

1811 Wilshire Blvd Ste 110
Santa Monica, CA 90403-5626

Mailing address

1811 Wilshire Blvd Ste 110
Santa Monica, CA 90403-5626
Phone (310) 829-0260

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210526002522 CA Practitioner - Dermatology 6002215399 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of California, Irvine, California College of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

12555 W Jefferson Blvd
Los Angeles, CA 90066-7032

1811 Wilshire Blvd
Santa Monica, CA 90403-5626

2336 Santa Monica Blvd
Suite 204
Santa Monica, CA 90404-2938
Phone (310) 829-6789

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.42 of 100Reported as group
Quality
96.07
Promoting interoperability
100
Improvement activities
40
Cost
71.98

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision69
Removal of skin lesions1463
Removal or shaving of skin growth11
Skin biopsy499

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A159681CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Jun 1, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jun 1, 2021 Accepting new patients
Providence Saint Johns Medical Foundation CurrentSince Jul 1, 2021 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Providence Saint John's Health Center Past Accepting new patients
Saint John's Health Clinic Past Accepting new patients

Locations

25825 Vermont Ave
Harbor City, CA 90710
Phone (310) 325-5111

12555 W Jefferson Blvd
#301
Los Angeles, CA 90066
Phone (424) 443-5555

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1811 Wilshire Blvd
Ste 110
Santa Monica, CA 90403
Phone (310) 453-9010

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

2336 Santa Monica Blvd
Ste 204
Santa Monica, CA 90404
Phone (310) 453-4477

8700 Beverly Blvd
Ste 5512
West Hollywood, CA 90048
Phone (310) 423-2811

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jzikry1665190@oc.providencedirect.org

Organizations & group practices 6

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 1

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": "1493683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647993600000",
    "number": "1366978918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 WILSHIRE BLVD STE 110",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035626",
            "telephone_number": "310-829-0260",
            "fax_number": "310-829-0263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 WILSHIRE BLVD STE 110",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904035626",
            "telephone_number": "310-829-0260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZIKRY",
        "first_name": "JOSEPH",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-02",
        "last_updated": "2022-03-23",
        "certification_date": "2022-03-23",
        "deactivation_date": "2018-06-11",
        "reactivation_date": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A159681",
            "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": "25825 Vermont Ave",
            "city": "Harbor City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "907103518",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.