Michael Babak Mortazie, DO

Primary specialty

MOHS-Micrographic Surgery PhysicianTaxonomy code 207ND0101X

License

14600 Issued in CA

Practice address

1506 E Chapman Ave
Orange, CA 92866-2231

Phone

(714) 538-8556

Fax

(714) 538-1082

NPI assigned

Jul 11, 2012

Sex

Male

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

Lake Erie College of Osteopathic Medicine, Erie, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jennifer Channual MD IncGroup PAC ID 8628333978, 8 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Jennifer Channual MD Inc

  • Dermatology Physician
  • Laguna Hills, CA
  • NPI 1710485982
  Medicare reassignment Care Compare group NPD
• Michael B. Mortazie, D.O. Inc.

  • Clinic/Center
  • Orange, CA
  • NPI 1316572183
  Medicare reassignment NPD Authorized official
• South Coast Dermatology Institute, a Medical Corporation

  • Dermatology Physician
  • Tustin, CA
  • NPI 1033241138
  Medicare reassignment NPD
• J. Robert West, M.D., Inc

  dba West Dermatology

  • Dermatology Physician
  • Phoenix, AZ
  • NPI 1114567997

  Mohs-Micrographic Surgery

  NPD (past)

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

{
    "created_epoch": "1341964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1457616914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 CORPORATE CIR",
            "address_2": "STE 200",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890747759",
            "telephone_number": "702-360-2763",
            "fax_number": "949-783-2880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 E CHAPMAN AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928662231",
            "telephone_number": "714-538-8556",
            "fax_number": "714-538-1082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORTAZIE",
        "first_name": "MICHAEL",
        "middle_name": "BABAK",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-11",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "CA",
            "license": "14600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Linsey Jane Morro
• Andrew Raymond Morrow, DC
• Kenneth Wesley Morrow, MD
• Kasra Morshedizadeh, M.D.
• Rod Mortazavi, M.D.
• Fernanda Pagnillo Morton, LCSW
• Mithya Jayakumar Morton
• Sara Christine Morton, PA-C
• Mosaic Mental Health Group
• Lauren Moser

• MOHS-Micrographic Surgery Physician in Orange, CA
• Providers in Orange, CA by specialty
• MOHS-Micrographic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.