Individual provider Active NPI

Nozar Amiri, M.D.

  • General Practice Physician
  • Glendale, CA
National Provider Identifier
1508074352
Registry record updated Oct 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A56376 Issued in CA
Practice address
111 N Maryland Ave Ste 201
Glendale, CA 91206-4238
Phone
(818) 790-5261
NPI assigned
May 17, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 27, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A56376 CA Primary

Addresses

Primary practice location

111 N Maryland Ave Ste 201
Glendale, CA 91206-4238

Mailing address

111 N Maryland Ave Ste 201
Glendale, CA 91206-4238
Phone (818) 790-5261

Other identifiers 1

IdentifierTypeStateIssuer
00A563760MedicaidCA

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
I20110620000265 CA Practitioner - General Practice 9931387024 Practice locations: Glendale, CA

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

117 W California Ave
Glendale, CA 91203-2211
Phone (818) 546-1688

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
56376CAMDDentist
A56376CAMDGeneral Practice Physician

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761523200000",
    "number": "1508074352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N MARYLAND AVE STE 201",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064238",
            "telephone_number": "818-790-5261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N MARYLAND AVE STE 201",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064238",
            "telephone_number": "818-790-5261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMIRI",
        "first_name": "NOZAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2025-10-27",
        "certification_date": "2025-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A56376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A563760",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.