NPIMap

Individual provider Active NPI

Jonathan Tavakoli, DPM

  • Foot & Ankle Surgery Podiatrist
  • Los Angeles, CA
National Provider Identifier
1467960690
Registry record updated Jan 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X
License
E5422 Issued in CA
Practice address
11932 Goshen Ave PH 1
Los Angeles, CA 90049-7309
Phone
(310) 651-0098
NPI assigned
Jan 22, 2018
Last updated
Jan 22, 2018By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Foot & Ankle Surgery Podiatrist 213ES0103X E5422 CA Primary

Addresses

Primary practice location

11932 Goshen Ave PH 1
Los Angeles, CA 90049-7309

Mailing address

11932 Goshen Ave PH 1
Los Angeles, CA 90049-7309

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
I20180808002571 CA Practitioner - Podiatry 0345598272 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Podiatry
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Omega Podiatry IncGroup PAC ID 5193004174, 2 clinicians

Practice addresses (Care Compare)

10518 Wilkins Ave
Los Angeles, CA 90024-6032
Phone (310) 651-0098

2137 E Cesar E Chavez Ave
Los Angeles, CA 90033-1843
Phone (323) 262-7450

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue219
Removal of nail tissue775
Removal or shaving of skin growth665

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
E5422CAMDFoot & Ankle Surgery Podiatrist

Practice roles

OrganizationSpecialtyStatusNew patients
Michael D. Kotzen, Inc. Foot & Ankle Surgery CurrentSince Sep 13, 2020 Accepting new patients
Omega Podiatry Inc. Foot & Ankle Surgery CurrentSince Apr 27, 2021 Accepting new patients
Home Foot Care, Inc. CurrentSince Jul 1, 2018 Accepting new patients
Jonathan Tavakoli DPM CurrentSince Dec 3, 2023 Accepting new patients
La Libertad Medical Clinic Inc. Past Accepting new patients

Locations

2137 E Cesar E Chavez Ave
Los Angeles, CA 90033
Phone (323) 260-7450

19231 Victory Blvd
Ste 456
Reseda, CA 91335
Phone (818) 349-8637

12520 Magnolia Blvd
Ste 304
Valley Vlg, CA 91607
Phone (818) 452-9902

7900 Pacific Blvd
Ste D
Walnut Park, CA 90255
Phone (323) 585-1056

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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 7

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": "1516579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516579200000",
    "number": "1467960690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11932 GOSHEN AVE PH 1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900497309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11932 GOSHEN AVE PH 1",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900497309",
            "telephone_number": "310-651-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVAKOLI",
        "first_name": "JONATHAN",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-22",
        "last_updated": "2018-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "E5422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.