Individual provider Active NPI

Iradj Ghadishah, M.D.

  • General Practice Physician
  • Culver City, CA
National Provider Identifier
1376564401
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A50282 Issued in CA
Practice address
9808 Venice Blvd
Suite 710
Culver City, CA 90232-2732
Phone
(310) 470-8220
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A50282 CA Primary

Addresses

Primary practice location

9808 Venice Blvd
Suite 710
Culver City, CA 90232-2732

Mailing address

10660 Wilshire Blvd
Suite 1108
Los Angeles, CA 90024-4522
Phone (310) 470-8220

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
I20040322001691 CA Practitioner - General PracticePractitioner - Family Practice 3678464401 Practice locations: Los Angeles, CA

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1961
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

10660 Wilshire Blvd
Apt 1108
Los Angeles, CA 90024-4526
Phone (310) 470-8220

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A50282CAMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Horacio F Ariza MD Past Accepting new patients

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376564401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10660 WILSHIRE BLVD",
            "address_2": "SUITE 1108",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900244522",
            "telephone_number": "310-470-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9808 VENICE BLVD",
            "address_2": "SUITE 710",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322732",
            "telephone_number": "310-470-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHADISHAH",
        "first_name": "IRADJ",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A50282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Culver City, CA

Sources for this page

Verify at the official NPI Registry.