NPIMap

Individual provider Active NPI

John Kenneth Conrad, M.D.

  • Vascular Surgery Physician
  • Burbank, CA
National Provider Identifier
1467452268
Registry record updated Sep 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
A74574 Issued in CA
Practice address
2950 W Burbank Blvd
Burbank, CA 91505-2309
Phone
(818) 842-4400
Fax
(818) 842-4401
NPI assigned
Jul 22, 2005
Last updated
Sep 28, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 31536 AZ
Vascular Surgery Physician 2086S0129X A74574 CA Primary

Addresses

Primary practice location

2950 W Burbank Blvd
Burbank, CA 91505-2309

Mailing address

23025 Sylvan St
Woodland Hills, CA 91367-1629
Phone (818) 558-7700

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
I20080326001002 CA Practitioner - Vascular Surgery 7719971506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of California, San Diego School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2950 W Burbank Blvd
Burbank, CA 91505-2309
Phone (818) 842-4400

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40
Cost
81.08

Procedures performed for Medicare patients

ProcedureNumber of procedures
Varicose vein removal35
Leg revascularization (restoring blood flow)29
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
31536AZMDVascular Surgery Physician
A74574CAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
La Vascular and Endovascular Surgery, a Medical Corporation Vascular Surgery CurrentSince Aug 1, 2008 Accepting new patients
Southwest Vascular Institute LTD Vascular Surgery Past Accepting new patients
Valley Vascular Imaging Inc Past Accepting new patients

Locations

2950 W Burbank Blvd
Ste 208
Burbank, CA 91505
Phone (818) 842-4400

2950 W Burbank Blvd
Burbank, CA 91505
Phone (818) 841-4100

18411 Clark St
Ste 305
Tarzana, CA 91356
Phone (818) 326-3406

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443398400000",
    "number": "1467452268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23025 SYLVAN ST",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913671629",
            "telephone_number": "818-558-7700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2950 W BURBANK BLVD",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915052309",
            "telephone_number": "818-842-4400",
            "fax_number": "818-842-4401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONRAD",
        "first_name": "JOHN",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-22",
        "last_updated": "2015-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "31536",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "A74574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.