NPIMap

Individual provider Active NPI

Kooros Samadzadeh, D.O.

  • Internal Medicine Physician
  • Ventura, CA
National Provider Identifier
1477598704
Registry record updated Jul 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A7918 Issued in CA
Practice address
147 N Brent St
Ventura, CA 93003-2809
Phone
(805) 652-5652
Fax
(805) 648-5982
NPI assigned
Jun 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20A7918 CA Primary

Addresses

Primary practice location

147 N Brent St
Ventura, CA 93003-2809

Mailing address

147 N Brent St
Ventura, CA 93003-2809
Phone (805) 652-5652

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
I20080311000267 CA Practitioner - Internal Medicine 3173608437 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Inpatient PhysiciansGroup PAC ID 4789998170, 35 clinicians

Practice addresses (Care Compare)

147 N Brent St
Ventura, CA 93003-2809
Phone (805) 652-5652

Hospital & facility affiliations

  • Community Memorial Hospital - Ventura Hospital, Ventura, CA, CCN 050394
  • Community Memorial Hospital - Ojai Hospital, Ojai, CA, CCN 051334
  • Community Memorial Hospital - Ojai Nursing home, CCN 05Z334
  • Community Memorial Continuing Care Center Nursing home, Ojai, CA, CCN 056200

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7918CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Health System CurrentSince Sep 1, 2022 Accepting new patients
Pacific Inpatient Physicians CurrentSince Jul 1, 2015 Accepting new patients
Community Memorial Health System Current Accepting new patients
Community Memorial Health System CurrentSince Sep 1, 2022 Accepting new patients

Locations

422 Arneill Rd
Ste B
Camarillo, CA 93010
Phone (805) 383-4510

1306 Maricopa Hwy
Ojai, CA 93023
Phone (805) 640-2260

2921 Saviers Rd
Oxnard, CA 93033
Phone (805) 487-5588

147 N Brent St
Ventura, CA 93003
Phone (805) 652-5011

138 W Main St
Ste E
Ventura, CA 93001
Phone (805) 667-2850

5855 Olivas Park Dr
Ventura, CA 93003
Phone (805) 652-5469

Interoperability endpoints

  • Direct secure messaging: kooros.samadzadeh.1@27638.direct.athenahealth.com

Organizations & group practices 4

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 12

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": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248220800000",
    "number": "1477598704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 N BRENT ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032809",
            "telephone_number": "805-652-5652",
            "fax_number": "805-648-5982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 N BRENT ST",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930032809",
            "telephone_number": "805-652-5652",
            "fax_number": "805-648-5982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMADZADEH",
        "first_name": "KOOROS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-19",
        "last_updated": "2009-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A7918",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ventura, CA

Sources for this page

Verify at the official NPI Registry.