Samreen Choudhry, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036138214 Issued in IL

Practice address

1617 Westcliff Dr Ste 214
Newport Beach, CA 92660

Phone

(949) 945-2374

NPI assigned

Sep 8, 2011

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kristen Forman MD IncGroup PAC ID 6204077191, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Kristen Forman MD Inc

  • Procedural Dermatology Physician
  • Newport Beach, CA
  • NPI 1073950325
  Medicare reassignment Care Compare group NPD
• Des Plaines Dermatology, LTD.

  • Dermatology Physician
  • Des Plaines, IL
  • NPI 1902127194
  NPD (past)

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

{
    "created_epoch": "1315440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529366400000",
    "number": "1447531017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1617 WESTCLIFF DR STE 214",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926605542",
            "telephone_number": "949-945-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1617 WESTCLIFF DR STE 214",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "92660",
            "telephone_number": "949-945-2374"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17742 Beach Blvd Ste 325",
            "address_purpose": "LOCATION",
            "city": "Huntington Beach",
            "state": "CA",
            "postal_code": "926476852",
            "country_code": "US",
            "telephone_number": "714-847-8561",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHOUDHRY",
        "first_name": "SAMREEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-09-08",
        "last_updated": "2018-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036138214",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lavinia K Chong, MD FACS
• Iris B Choo, M.D.
• Pooja R Chopra, MD
• Shivani Chopra, M.D.
• Janice C Chou, D.D.S.
• Calvin Chow, PT, DPT
• Carol Jacquelyn Chow, FNP-C
• Chris Esguerra MD PC
• John Branson Chrispens, D.D.S.
• Moniqua Elena Christensen

• Dermatology Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Dermatology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2018; 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.
• 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.