Harley Ian Kornblum, M.D.

Primary specialty

Pediatric Neurodevelopmental Disabilities PhysicianTaxonomy code 2080P0008X

License

G70261 Issued in CA

Practice address

10833 Le Conte Ave
12-441 MDCC
Los Angeles, CA 90095-3075

Phone

(310) 206-3952

Fax

(310) 206-0209

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Merit-based Incentive Payment System (MIPS)

Final score

77.64 of 100Reported as group

Quality

82.13

Promoting interoperability

100

Improvement activities

40

Cost

10

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hkornblum37745@direct.uclahealth.org

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.

• UC Regents

  • Pediatrics Physician
  • Los Angeles, CA
  • NPI 1982667663
  Medicare reassignment NPD
• UCLA Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1043427248
  NPD (past)
• UCLA Pediatrics

  • Clinical & Laboratory Immunology (Allergy & Immunology) Physician
  • Los Angeles, CA
  • NPI 1255528055
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340150400000",
    "number": "1386651115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE",
            "address_2": "12-441 MDCC",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900953075",
            "telephone_number": "310-206-3952",
            "fax_number": "310-206-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10833 LE CONTE AVE",
            "address_2": "12-441 MDCC",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900953075",
            "telephone_number": "310-206-3952",
            "fax_number": "310-206-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNBLUM",
        "first_name": "HARLEY",
        "middle_name": "IAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2012-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0008X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neurodevelopmental Disabilities",
            "state": "CA",
            "license": "G70261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G702610",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0053510",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elika Kormeili, MFT
• William Mark Korn, LCSW, MSW, M.ED.
• Rosalynn Kornak
• Daniel Leon Kornberg, M.D.
• Donald Kornblau, DDS
• Penelope Grace Kornbluth, R.N, NP, MSN
• Herbert R Kornfeld, M.D.
• David Samuel Kornsand, M.D.
• Coco Celia Kornspan
• Lacin Koro

• Pediatric Neurodevelopmental Disabilities Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatric Neurodevelopmental Disabilities Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; 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.