Active NPI
Mirza Raheem, M.D.
- Internal Medicine Physician
- La Jolla, CA
National Provider Identifier
1609886647
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 140215
- Practice address
- 9850 Genesee Ave Ste 320
La Jolla, CA 92037-1208 - Phone
- (858) 554-1212
- Fax
- (858) 795-1195
- NPI assigned
- Aug 9, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 140215 | CA | Primary |
Addresses
Primary practice location
9850 Genesee Ave Ste 320
La Jolla, CA 92037-1208
Mailing address
1501 Wabash St Ste 105
Michigan City, IN 46360-4364
Phone (219) 878-1300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100095230C | Medicaid | IN |
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
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 92.17 of 100
- Quality
- 100
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.9
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 140215 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Monica Perlman MD Inc. | Single Specialty | Current | Accepting new patients |
| Ekg Associates | Single Specialty | Past | Accepting new patients |
Locations
9850 Genesee Ave
Ste 320
La Jolla, CA 92037
Phone (858) 864-9800
3737 Moraga Ave
Ste B103
San Diego, CA 92117
Phone (858) 799-0855
12843 El Camino Real
Ste 203
San Diego, CA 92130
Phone (858) 558-0399
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155081600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593648000000",
"number": "1609886647",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1501 WABASH ST STE 105",
"city": "MICHIGAN CITY",
"state": "IN",
"postal_code": "463604364",
"telephone_number": "219-878-1300",
"fax_number": "219-878-9764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9850 GENESEE AVE STE 320",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920371208",
"telephone_number": "858-554-1212",
"fax_number": "858-795-1195"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RAHEEM",
"first_name": "MIRZA",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-09",
"last_updated": "2020-07-02",
"certification_date": "2020-07-02",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": "CA",
"license": "140215",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100095230C",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2020; 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.