Paul C Fan, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G62619 Issued in CA

Practice address

1516 Cotner Ave
Los Angeles, CA 90025-3303

Phone

(310) 445-2951

Fax

(310) 479-1459

NPI assigned

Jul 11, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Merit-based Incentive Payment System (MIPS)

Final score

91.25 of 100Reported as group

Quality

75

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

91.25 of 100Reported as group

Quality

75

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Pronet Imaging Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Los Angeles, CA
  • NPI 1528099488
  Medicare reassignment NPD
• San Fernando Valley Interventional Radiology and Imaging Center

  • Vascular-Interventional Technology Radiologic Technologist
  • Encino, CA
  • NPI 1942350889
  Medicare reassignment NPD
• Beverly Radiology Medical Group

  • Diagnostic Radiology Physician
  • Lancaster, CA
  • NPI 1306884648
  NPD (past)
• Kern Radiology Medical Group, Inc

  • Diagnostic Radiology Physician
  • Bakersfield, CA
  • NPI 1720023997
  NPD (past)
• Radmol Pet Center, LLC

  • Diagnostic Radiology Physician
  • Palm Springs, CA
  • NPI 1770513483
  NPD (past)

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391126400000",
    "number": "1487689188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 COTNER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900253303",
            "telephone_number": "310-445-2951",
            "fax_number": "310-479-1459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 COTNER AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900253303",
            "telephone_number": "310-445-2951",
            "fax_number": "310-479-1459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAN",
        "first_name": "PAUL",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2014-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G62619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00F626190",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G626190",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob C. Fan, MD
• Jennie Jessica Fan, OD
• Jessica Fan, MD
• Judith Fan, M.S.
• Michael S. Fan, MD
• Robert Fan, M.D.
• Shutieng Fan, PHARMD
• Zhaoyang Fan, PHD
• Mania Fanaeian, MS, RD, CNSC
• Sara Fanai Khayat, DC

• Diagnostic Radiology Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; 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.