NPIMap

Organization Active NPI

Los Angeles Hematology-Oncology Medical Group

  • Hematology & Oncology Physician
  • Glendale, CA
National Provider Identifier
1386859122
Registry record updated May 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
LOS ANGELES HEMATOLOGY-ONCOLOGY MEDICAL GROUP
Practice address
222 W Eulalia St
Suite 100C
Glendale, CA 91204-2849
Phone
(818) 553-8160
Fax
(818) 553-8152
NPI assigned
May 14, 2007
Last updated
May 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2021

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

Authorized official

Name
Dr. Boris Bagdasrian, D.O.
Title
Partner
Phone
(818) 409-0105

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X Primary

Addresses

Primary practice location

222 W Eulalia St
Suite 100C
Glendale, CA 91204-2849

Mailing address

541 W Colorado St Ste 205
Glendale, CA 91204-3640
Phone (323) 254-0046

Other identifiers 1

IdentifierTypeStateIssuer
GR0051271MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050601001068 CA Part B Supplier - Clinic/Group Practice 6608819594 Receives reassigned benefits from 70 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Anaheim, CA; Mission Hills, CA; Montebello, CA; Northridge, CA; Pasadena, CA; Pomona, CA; Redlands, CA…

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

222 W Eulalia St
Ste 100C
Glendale, CA 91204
Phone (818) 553-8160

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621814400000",
    "number": "1386859122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 W COLORADO ST STE 205",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912043640",
            "telephone_number": "323-254-0046",
            "fax_number": "323-488-9782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 W EULALIA ST",
            "address_2": "SUITE 100C",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042849",
            "telephone_number": "818-553-8160",
            "fax_number": "818-553-8152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOS ANGELES HEMATOLOGY-ONCOLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2021-05-24",
        "certification_date": "2021-05-24",
        "status": "A",
        "authorized_official_last_name": "BAGDASRIAN",
        "authorized_official_first_name": "BORIS",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "818-409-0105",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0051271",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.