NPIMap

Individual provider Active NPI

Jeffrey A Glick, M.D.

  • Nephrology Physician
  • North Hollywood, CA
National Provider Identifier
1477533511
Registry record updated Sep 12, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G58181 Issued in CA
Practice address
12660 Riverside Dr
Suite 225
North Hollywood, CA 91607-3429
Phone
(818) 487-0040
Fax
(818) 487-0050
NPI assigned
Jan 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G58181 CA
Nephrology Physician 207RN0300X G58181 CA Primary

Addresses

Primary practice location

12660 Riverside Dr
Suite 225
North Hollywood, CA 91607-3429

Mailing address

5805 Sepulveda Blvd
Suite 610
Van Nuys, CA 91411-2546
Phone (818) 908-8048

Other identifiers 1

IdentifierTypeStateIssuer
00G581810MedicaidCA

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
I20100616000759 CA Practitioner - NephrologyPractitioner - Internal Medicine 0840387635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of California, Irvine, California College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Cedars-Sinai Medical Care FoundationGroup PAC ID 0941106645, 1,684 clinicians

Practice addresses (Care Compare)

12660 Riverside Dr
Suite 215
North Hollywood, CA 91607-3430
Phone (818) 487-0040

Hospital & facility affiliations

  • Fresenius Medical Care Burbank Dialysis facility, Burbank, CA, CCN 052549
  • Fresenius Medical Care Van Nuys Dialysis facility, Van Nuys, CA, CCN 552701
  • Pegasus Home Health Care, Inc. Home health agency, Glendale, CA, CCN 557479
  • Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235
  • Providence Cedars Sinai Tarzana Medical Center Hospital, Tarzana, CA, CCN 050761
  • Cedars-Sinai Medical Center Hospital, Los Angeles, CA, CCN 050625
  • Usc Verdugo Hills Hospital Hospital, Glendale, CA, CCN 050124

Merit-based Incentive Payment System (MIPS)

Final score
89.14 of 100Reported as group
Quality
84.79
Promoting interoperability
99
Improvement activities
40
Cost
73.15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G58181CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kamyar Kamjoo MD a Medical Corporation Nephrology Current Accepting new patients
Cedars-Sinai Medical Care Foundation CurrentSince Oct 15, 2014 Accepting new patients
Michael S. Malamed, M.D., a Medical Corporation Internal Medicine Current Accepting new patients
St Joseph Regional Health Network Past Accepting new patients
Yaroslav a. Gofnung, M.D., Inc. Past Accepting new patients
Valley Presbyterian Hospital Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients
Cedars-Sinai Medical Center Past Accepting new patients

Locations

8635 W 3rd St
Ste 465W
Los Angeles, CA 90048
Phone (310) 423-0674

12660 Riverside Dr
Ste 225
North Hollywood, CA 91607
Phone (818) 487-0040

4140 W 190th St
Torrance, CA 90504
Phone (310) 967-1780

12660 Riverside Dr
Ste 215
Valley Vlg, CA 91607
Phone (818) 487-0040

15211 Vanowen St
Ste 315
Van Nuys, CA 91405
Phone (818) 785-1645

15211 Vanowen St
Ste 300
Van Nuys, CA 91405
Phone (818) 782-4104

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jglick209466@direct.cshs.org

Organizations & group practices 8

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.

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": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505174400000",
    "number": "1477533511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5805 SEPULVEDA BLVD",
            "address_2": "SUITE 610",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914112546",
            "telephone_number": "818-908-8048",
            "fax_number": "818-908-8072"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12660 RIVERSIDE DR",
            "address_2": "SUITE 225",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916073429",
            "telephone_number": "818-487-0040",
            "fax_number": "818-487-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICK",
        "first_name": "JEFFREY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2017-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G58181",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G58181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G581810",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Hollywood, CA

Sources for this page

Verify at the official NPI Registry.