Individual provider Active NPI

Roger J. Mah, M.D.

  • Anesthesiology Physician
  • Santa Monica, CA
National Provider Identifier
1477564185
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
G77107 Issued in CA
Practice address
1328 22ND St
Santa Monica, CA 90404-2032
Phone
(310) 829-8202
NPI assigned
Aug 10, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G77107 CA Primary

Addresses

Primary practice location

1328 22ND St
Santa Monica, CA 90404-2032

Mailing address

11999 San Vicente Blvd
#440
Los Angeles, CA 90049-5131
Phone (310) 471-5852

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20111227000475 CA Practitioner - Anesthesiology 4587830419 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical College of Pennsylvania, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

12400 Wilshire Blvd
Suite 100
Los Angeles, CA 90025-1067
Phone (310) 442-5566

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G77107CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Roger Joseph Mah Corporation Anesthesiology CurrentSince Aug 7, 2023 Accepting new patients
Bayside Anesthesia Medical Group CurrentSince Jan 1, 2001 Accepting new patients

Locations

12400 Wilshire Blvd
Ste 100
Los Angeles, CA 90025
Phone (310) 422-5566

1328 22nd St
Santa Monica, CA 90404
Phone (310) 829-5511

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477564185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11999 SAN VICENTE BLVD",
            "address_2": "#440",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900495131",
            "telephone_number": "310-471-5852",
            "fax_number": "310-471-3958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1328 22ND ST",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042032",
            "telephone_number": "310-829-8202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAH",
        "first_name": "ROGER",
        "middle_name": "J.",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G77107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.