NPIMap

Organization Active NPI

Kidney Consultants Medical Group, Inc

  • Specialist
  • Mission Hills, CA
National Provider Identifier
1427120682
Registry record updated Nov 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
KIDNEY CONSULTANTS MEDICAL GROUP, INC
Practice address
11550 Indian Hills Rd
Suite 371
Mission Hills, CA 91345-1252
Phone
(818) 365-1194
Fax
(818) 898-3835
NPI assigned
Nov 14, 2006
Last updated
Nov 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2018

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

Authorized official

Name
Mr. Omaran Abdeen, M.DNPI 1700878410
Title
President
Phone
(818) 365-1194

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

11550 Indian Hills Rd
Suite 371
Mission Hills, CA 91345-1252

Mailing address

11550 Indian Hills Rd
Suite 371
Mission Hills, CA 91345-1252
Phone (818) 365-1194

Other identifiers 1

IdentifierTypeStateIssuer
GR0068770MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040819001633 CA Part B Supplier - Clinic/Group Practice 5597739276 Receives reassigned benefits from 22 practitioners
Practice locations: Mission Hills, CA; Santa Clarita, CA

National Provider Directory

National Provider Directory

Locations

11550 Indian Hills Rd
Ste 371
Mission Hills, CA 91345
Phone (818) 365-1194

23421 Lyons Ave
Valencia, CA 91355
Phone (661) 753-9891

27420 Tourney Rd
Ste 200
Valencia, CA 91355
Phone (661) 254-9950

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541462400000",
    "number": "1427120682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11550 INDIAN HILLS RD",
            "address_2": "SUITE 371",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451252",
            "telephone_number": "818-365-1194",
            "fax_number": "818-898-3835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11550 INDIAN HILLS RD",
            "address_2": "SUITE 371",
            "city": "MISSION HILLS",
            "state": "CA",
            "postal_code": "913451252",
            "telephone_number": "818-365-1194",
            "fax_number": "818-898-3835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CONSULTANTS MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2018-11-06",
        "status": "A",
        "authorized_official_last_name": "ABDEEN",
        "authorized_official_first_name": "OMARAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-365-1194",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0068770",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2018; 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.