Individual provider Active NPI

Allan Pantuck, MD

  • Urology Physician
  • Los Angeles, CA
National Provider Identifier
1386663227
Registry record updated Jan 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
G85029 Issued in CA
Practice address
200 UCLA Medical PLZ Ste 140
Los Angeles, CA 90095-3075
Phone
(310) 794-7152
Fax
(310) 794-1666
NPI assigned
Jul 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X G85029 CA Primary
Surgical Oncology Physician 2086X0206X G85029 CA

Addresses

Primary practice location

200 UCLA Medical PLZ Ste 140
Los Angeles, CA 90095-3075

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other identifiers 1

IdentifierTypeStateIssuer
00G850290MedicaidCA

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
I20100806000603 CA Practitioner - Urology 0143353417 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Regents of the University of CaliforniaGroup PAC ID 3678545431, 47 clinicians

Practice addresses (Care Compare)

200 UCLA Medical PLZ
Suite 140
Los Angeles, CA 90095-3075
Phone (310) 825-5986

200 UCLA Medical PLZ
Suite B265
Los Angeles, CA 90095-0001
Phone (310) 825-0128

300 Stein Plaza
FL 3 Suite 331
Los Angeles, CA 90095-0001
Phone (310) 794-8492

300 Stein PLZ
FL 3
Los Angeles, CA 90095-0001
Phone (310) 794-7700

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.3 of 100Reported as group
Quality
80.56
Promoting interoperability
100
Improvement activities
40
Cost
73.78

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
85029CAMDMarriage & Family Therapist
G85029CAMDSurgical Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Regents of the University of California Urology CurrentSince Jul 1, 1999 Accepting new patients
UCLA Urology Associates Urology Past Accepting new patients

Locations

10833 Le Conte Ave
Los Angeles, CA 90095
Phone (310) 301-8932

File 2939
Los Angeles, CA 90074
Phone (310) 794-6596

200 UCLA Medical Plz
Ste 140
Los Angeles, CA 90095
Phone (310) 206-8164

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

200 Medical Plz
Ste 140
Los Angeles, CA 90095
Phone (310) 206-1434

Interoperability endpoints

  • Direct secure messaging: apantuck43482@direct.uclahealth.org

Organizations & group practices 2

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578528000000",
    "number": "1386663227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ STE 140",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900953075",
            "telephone_number": "310-794-7152",
            "fax_number": "310-794-1666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANTUCK",
        "first_name": "ALLAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "G85029",
            "primary": true
        },
        {
            "code": "2086X0206X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Oncology",
            "state": "CA",
            "license": "G85029",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G850290",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.