Elena Khavshaba

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F11220384 Issued in CA

Practice address

2621 Honolulu Ave
Montrose, CA 91020-1706

Phone

(818) 726-7220

NPI assigned

Nov 28, 2022

Sex

Female

Sole proprietor

No

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

Nurse Practitioner

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Altea Medical California PCGroup PAC ID 1850740150, 84 clinicians

David Taftian DO IncGroup PAC ID 4385980358, 18 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations (25 of 69)

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19088/brand/1/csg/1/fhir/r4

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.

• Altea Medical California PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Eureka, CA
  • NPI 1174302954
  Medicare reassignment Care Compare group NPD
• David Taftian DO, Inc

  • Physical Medicine & Rehabilitation Physician
  • Reseda, CA
  • NPI 1366917361
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682640000000",
    "number": "1487364808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 RICHARD PL",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912063463",
            "telephone_number": "818-726-7220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2621 HONOLULU AVE",
            "city": "MONTROSE",
            "state": "CA",
            "postal_code": "910201706",
            "telephone_number": "818-726-7220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAVSHABA",
        "first_name": "ELENA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-28",
        "last_updated": "2023-04-28",
        "certification_date": "2023-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "F11220384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Juwon Kang
• Kathleen Dennis-Zarate MD
• Amoret Kaufman, LMFT
• Debra T Kessler, PSY.D.
• Zohrab Khacheryan
• In Woo Kim
• Julie Eunkyung Kim, D.D.S.
• Miju Kim, OTD
• Kinetic Conditioning Institute, Inc
• Christine Alain Kreger, LMFT

• Family Nurse Practitioner in Montrose, CA
• Providers in Montrose, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.