Gholamreza Rezvani, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401417703 Issued in CA

Practice address

207 N Butte St
Willows, CA 95988-2803

Phone

(530) 934-4641

NPI assigned

Oct 29, 2021

Sex

Male

Sole proprietor

No

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Lake County Tribal Health Consortium Inc.

  • Federally Qualified Health Center (FQHC)
  • Lakeport, CA
  • NPI 1881697381
  Medicare reassignment NPD
• Lake County Tribal Health Southshore Clinic

  • Federally Qualified Health Center (FQHC)
  • Clearlake, CA
  • NPI 1063158038
  NPD

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

{
    "created_epoch": "1635465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635465600000",
    "number": "1437813029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CROSS ST",
            "city": "WOODLAND",
            "state": "CA",
            "postal_code": "956954128",
            "telephone_number": "650-808-0855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 N BUTTE ST",
            "city": "WILLOWS",
            "state": "CA",
            "postal_code": "959882803",
            "telephone_number": "530-934-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZVANI",
        "first_name": "GHOLAMREZA",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-29",
        "last_updated": "2021-10-29",
        "certification_date": "2021-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "0401417703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca R Boening MD Inc
• Jessica Kate Rector, PT, DPT
• David Reed, DDS
• Tatjana Sue Rei
• Joanne Elizabeth Reid, M.D.
• Isabel Robles
• Nikolai Rodionov
• Xochitl Rodriguez, M.S. PPS
• Cynthia Beth Ross
• Laura Elizabeth Roten

• General Practice Dentistry in Willows, CA
• Providers in Willows, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.