Jafar Koupaie, MD

Key facts

NPI

1508940644

Entity type

Individual (NPI type 1)

Primary specialty

Procedural Dermatology Physician 207NS0135X

License

C51581 (CA)

Practice address

9889 Magnolia Ave Ste a
Riverside, CA 92503-3581

Phone

(951) 566-5634

NPI assigned

Oct 25, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 7

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.

• Baraye Dermatology Physician · Irvine, CA · NPI 1760174882
  Medicare reassignment Care Compare group NPD CA · DERMATOLOGY
• Advanced Dermatology & Skin Cancer Specialists Dermatology Physician · Temecula, CA · NPI 1881023927
  Medicare reassignment Care Compare group CA
• Canton Dermatology Clinic, Inc Procedural Dermatology Physician · Canton, MA · NPI 1295819290
  Medicare reassignment Authorized official MA
• My Skin Institute, Inc Dermatology Physician · Turlock, CA · NPI 1427352053
  Medicare reassignment NPD CA · DERMATOLOGY
• Hayes B. Gladstone, MD, PC. Dermatology Physician · Danville, CA · NPI 1376947978
  Medicare reassignment CA
• Edmund Yao MD Inc Internal Medicine Physician · Stockton, CA · NPI 1285969139
  NPD
• Temecula Valley Family Physicians Inc. Family Medicine Physician · Temecula, CA · NPI 1033323746
  NPD (past)

Medicare Care Compare profile

Specialty

Dermatology

Education

Other, 1970

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Advanced Dermatology and Skin Cancer Specialists (20 clinicians)
Baraye (3 clinicians)

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled (2 enrollments) in MA, CA

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles (4 of 5)

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: advanceddermatologyandskin.jafarkoupaie@127196.advancedmd-direct.com

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 12, 2023.

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1508940644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 WASHINGTON ST",
            "city": "CANTON",
            "state": "MA",
            "postal_code": "020214006",
            "telephone_number": "781-821-2888",
            "fax_number": "781-821-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9889 MAGNOLIA AVE STE A",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925033581",
            "telephone_number": "951-566-5634"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "95 Washington St",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "MA",
            "postal_code": "020214006",
            "country_code": "US",
            "telephone_number": "781-821-2888",
            "fax_number": "781-821-8684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOUPAIE",
        "first_name": "JAFAR",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "MA",
            "license": "54177",
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "CA",
            "license": "C51581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Riverside, CA · Procedural Dermatology Physician in California