Active NPI
Kourosh Darren Bagheri, M.D., M.S.
- Internal Medicine Physician
- Shell Beach, CA
National Provider Identifier
1457540031
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- G77496
- Practice address
- 170 Seacliff Dr
Shell Beach, CA 93449-1715 - Phone
- (805) 781-9111
- Fax
- (818) 208-8250
- NPI assigned
- Oct 18, 2007
- Last updated
- Dec 28, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | G77496 | CA | Primary |
Addresses
Primary practice location
170 Seacliff Dr
Shell Beach, CA 93449-1715
Mailing address
1177 Marsh St Ste 100
San Luis Obispo, CA 93401-2316
Phone (805) 781-9111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G77496 | CA | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Health Aging & Independence for All Fund Fatigue Clinic | Current | Accepting new patients | |
| Templeton Institute for Neurology Inc | Past | Accepting new patients | |
| California Em-I Medical Services | Past | Accepting new patients |
Organizations & group practices 4
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.
-
dba Healthy Aging & Independence for All Fund Fatigue Clinic
- Health Service Clinic/Center
- Berkeley, CA
- NPI 1477266013
-
dba Bagheri Medical Group
- Internal Medicine Physician
- Berkeley, CA
- NPI 1740367275
-
- Emergency Medicine Physician
- San Francisco, CA
- NPI 1649229600
-
- Neurology Physician
- Templeton, CA
- NPI 1356673602
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192665600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672185600000",
"number": "1457540031",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1177 MARSH ST STE 100",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934012316",
"telephone_number": "805-781-9111",
"fax_number": "805-788-0764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "170 SEACLIFF DR",
"city": "SHELL BEACH",
"state": "CA",
"postal_code": "934491715",
"telephone_number": "805-781-9111",
"fax_number": "818-208-8250"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGHERI",
"first_name": "KOUROSH",
"middle_name": "DARREN",
"name_prefix": "Dr.",
"credential": "M.D., M.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-18",
"last_updated": "2022-12-28",
"certification_date": "2022-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CA",
"license": "G77496",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shell Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.