Mastaneh Nikravesh, MD

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

A176795 Issued in CA

Practice address

5555 Grossmont Center Dr
La Mesa, CA 91942-3019

Phone

(619) 740-6000

NPI assigned

Apr 18, 2019

Last updated

Mar 11, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, CA2 enrollments

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 2

Specialty

Internal Medicine

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Zachary C Cohen MD ApcGroup PAC ID 6608260179, 15 clinicians

San Diego Critical Care Medical Group IncGroup PAC ID 7911083886, 74 clinicians

Emergency and Acute Care Medical CorporationGroup PAC ID 9537108279, 431 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grossmont Hospital Hospital, La Mesa, CA, CCN 050026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: mnikravesh931099@direct.emplifyhealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergency and Acute Care Medical Corporation

  • Emergency Medicine Physician
  • San Diego, CA
  • NPI 1437103942
  Medicare reassignment Care Compare group NPD
• San Diego Critical Care Medical Group, Inc

  • Internal Medicine Physician
  • El Cajon, CA
  • NPI 1609915990
  Medicare reassignment Care Compare group NPD
• Zachary C Cohen MD Apc

  dba California Pain Consultants

  • Pain Medicine Physician
  • San Diego, CA
  • NPI 1689334468
  Medicare reassignment Care Compare group NPD
• Gundersen Lutheran Medical Center Inc

  dba Emplify Health Hamilton Clinic

  • Clinic/Center
  • La Crosse, WI
  • NPI 1225873458
  Medicare reassignment NPD
• Mastaneh Nikravesh MD PC

  • Addiction Medicine (Internal Medicine) Physician
  • San Diego, CA
  • NPI 1982585980
  NPD Authorized official
• Comprehensive Pain ASC, LLC

  • Ambulatory Surgical Clinic/Center
  • San Diego, CA
  • NPI 1124406632
  Medicare reassignment
• Zachary C Cohen MD Apc

  dba California Pain Consultants

  • Interventional Pain Medicine Physician
  • San Diego, CA
  • NPI 1790589570
  NPD
• Gundersen Lutheran Medical Center Inc

  dba Emplify Health Green Bay Building

  • Clinic/Center
  • La Crosse, WI
  • NPI 1790502797
  NPD
• Gundersen Lutheran Medical Center, Inc

  dba Emplify Health Onalaska Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Onalaska, WI
  • NPI 1871837567
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Grossmont Hospital Corporation

  dba Sharp Grossmont Hospital

  • General Acute Care Hospital
  • La Mesa, CA
  • NPI 1528041811
  Care Compare affiliation

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

{
    "created_epoch": "1555545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741651200000",
    "number": "1508429143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 1ST AVE STE 102-2405",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981042210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 GROSSMONT CENTER DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423019",
            "telephone_number": "619-740-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3434 Midway Dr Ste 2001",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921104924",
            "country_code": "US",
            "telephone_number": "619-325-1161",
            "fax_number": "619-325-1717",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIKRAVESH",
        "first_name": "MASTANEH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-18",
        "last_updated": "2025-03-11",
        "certification_date": "2025-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A176795",
            "primary": false
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "CA",
            "license": "A176795",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "CA",
            "license": "A176795",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vinh Duc Nguyen, M.D.
• Samantha Nichols
• Jessica Brooke Niebrugge, PT
• Natalie Niedzwiedz, PT, DPT
• Nightingale Home Care, Inc.
• Rhealynn Sison Nofuente, FNP-C
• Christine Mae Nordling, MD
• Rileigh Olivia Norman, PA-C
• North County Lifeline
• Northland Hearing Centers, Inc. (The Hearing Aid Store)

• Pain Medicine Physician in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Pain Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2025; 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.