NPIMap

Individual provider Active NPI

Ahmad Reza Ellini, MD

  • Pediatric Cardiology Physician
  • Orange, CA
National Provider Identifier
1427144666
Registry record updated Jan 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
A122753 Issued in CA
Practice address
1010 W la Veta Ave
Suite 575
Orange, CA 92868-4300
Phone
(714) 547-0900
Fax
(714) 547-2080
NPI assigned
Oct 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X D71188 MD
Pediatric Cardiology Physician 2080P0202X A122753 CA Primary

Addresses

Primary practice location

1010 W la Veta Ave
Suite 575
Orange, CA 92868-4300

Mailing address

1010 W la Veta Ave
Suite 575
Orange, CA 92868-4300
Phone (714) 547-0900

Other identifiers 1

IdentifierTypeStateIssuer
410880901MedicaidMD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121026000279 CA Practitioner - Pediatric Medicine 8224030549

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A122753CAMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Saddleback Memorial Medical Center Past Accepting new patients
Los Alamitos Medical Center, Inc. Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
Hoag Hospital Past Accepting new patients
Long Beach Memorial Medical Past Accepting new patients
St. Joseph Hospital Past Accepting new patients
University of Maryland Medical Center, LLC Past Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Providence Health System Southern California Past Accepting new patients
Children's Hospital of Orange County Past Accepting new patients
Hoag Memorial Hospital Presbyterian Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients
Pediatric Subspecialty Faculty, Inc. Past Accepting new patients
Tri-City Hospital Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 14

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.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358812800000",
    "number": "1427144666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 W LA VETA AVE",
            "address_2": "SUITE 575",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684300",
            "telephone_number": "714-547-0900",
            "fax_number": "714-547-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W LA VETA AVE",
            "address_2": "SUITE 575",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684300",
            "telephone_number": "714-547-0900",
            "fax_number": "714-547-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINI",
        "first_name": "AHMAD REZA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2013-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MD",
            "license": "D71188",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "A122753",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410880901",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.