Elda Petrosyan, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95027679 Issued in CA

Practice address

8256 Saint Clair Ave
North Hollywood, CA 91605-1327

Phone

(818) 859-0503

NPI assigned

Jan 18, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Shine MMG IncGroup PAC ID 6103257282, 25 clinicians

California Mobile Medical Group IncGroup PAC ID 7719330091, 16 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Calstate Healthcare Inc.

  dba Calstate Halthcare INC.

  • Home Health Agency
  • Van Nuys, CA
  • NPI 1972137891

  W-2 Managing Employee

  CMS ownership

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.

• California Mobile Medical Group Inc

  dba The Mobile DRS

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1588439061

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Shine MMG Inc

  dba Shine MMG

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1053930248

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Meri Medical Management Inc

  • General Practice Physician
  • Glendale, CA
  • NPI 1649076878

  Single Specialty

  Medicare reassignment NPD
• Mobile Medical Group Inc

  dba TMD

  • Family Medicine Physician
  • Glendale, CA
  • NPI 1487169660

  Single Specialty

  Medicare reassignment NPD
• Calstate Healthcare Inc.

  dba Calstate Halthcare INC.

  • Home Health Agency
  • Van Nuys, CA
  • NPI 1972137891
  NPD (past)

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

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1396506283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8256 SAINT CLAIR AVE",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916051327",
            "telephone_number": "818-859-0503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8256 SAINT CLAIR AVE",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916051327",
            "telephone_number": "818-859-0503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETROSYAN",
        "first_name": "ELDA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95027679",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tony Perry
• Perspective Home Health Care, Inc
• Urszula Perzanowska, LVN/LPN
• Peter Swerdlick, M.D. Inc.
• Arman Petrosyan
• Nare Petrosyan
• Pharmacy Homecare Network
• Pharmacy Homecare Network
• Pharmedquest Pharmacy Services (Avita Pharmacy 1008)
• Devohn Paris Phillips

• Family Nurse Practitioner in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; 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.