Nadia Tavakkoli, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA63148 Issued in CA

Practice address

9 Del Torino
Lake Elsinore, CA 92532-0204

Phone

(951) 623-3941

NPI assigned

Jul 3, 2023

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wound Care 360 Advanced Solutions IncGroup PAC ID 2769912906, 12 clinicians

MGM Physician Assistant IncGroup PAC ID 5890132096, 9 clinicians

Wound Care First CorpGroup PAC ID 1850884289, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: nadia.tavakkoli.p49@direct.kmsm.nextgenshare.com

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.

• MGM Physician Assistant Inc

  • Surgical Physician Assistant
  • Riverside, CA
  • NPI 1023871779
  Medicare reassignment Care Compare group NPD
• Wound Care First Corp

  • Family Medicine Physician
  • Anaheim, CA
  • NPI 1316829369
  Medicare reassignment Care Compare group
• Wound Care 360 Advanced Solutions Inc

  • General Practice Physician
  • Encinitas, CA
  • NPI 1942012539
  Care Compare group
• Empire Wound Care

  • General Practice Physician
  • Monrovia, CA
  • NPI 1710796792
  NPD
• Southern California Primary Care Medical Group, Inc

  • Family Medicine Physician
  • Lake Elsinore, CA
  • NPI 1376632281
  NPD (past)

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

{
    "created_epoch": "1688342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1477230225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 DEL TORINO",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320204",
            "telephone_number": "951-623-3941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 DEL TORINO",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320204",
            "telephone_number": "951-623-3941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVAKKOLI",
        "first_name": "NADIA",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Mary Tagney
• George Takeda
• Christine Balmes Tan, RNFA
• Maritza Tapia-Barrera
• Nicole Elemento Tatunay
• Lindsay Taylor, IBCLC, MS
• Angelica Terrazas
• The Happier Life Project
• The Loyalty House
• The Social Work Action Group

• Physician Assistant in Lake Elsinore, CA
• Providers in Lake Elsinore, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; 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.