Individual provider Active NPI

Rana Rofagha Sajjadian, MD

  • Dermatology Physician
  • Mission Viejo, CA
National Provider Identifier
1629043054
Registry record updated Dec 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
A-95792 Issued in CA
Practice address
23781 Maquina Ave.
Southern California Permanente Medical Group
Mission Viejo, CA 92691-2716
Phone
(412) 965-7204
NPI assigned
Feb 21, 2006
Last updated
Dec 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A-95792 CA Primary

Addresses

Primary practice location

23781 Maquina Ave.
Southern California Permanente Medical Group
Mission Viejo, CA 92691-2716

Mailing address

23781 Maquina Ave.
Southern California Permanente Medical Group
Mission Viejo, CA 92691-2716
Phone (412) 965-7204

Other identifiers 1

IdentifierTypeStateIssuer
101351003MedicaidPA

Other names 1

  • Dr. Rana Rofagha Professional name

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20081119000196 CA Practitioner - Dermatology 4981637576 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Ohio State University College of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5475 E la Palma Ave
Anaheim, CA 92807-2075
Phone (714) 279-6088

6 Willard
Irvine, CA 92604-4694
Phone (949) 262-5600

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin cancer1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A-95792CAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Aug 29, 2010 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Aug 29, 2010 Accepting new patients

Locations

441 N Lakeview Ave
Anaheim, CA 92807
Phone (714) 279-4000

5475 E La Palma Ave
Anaheim, CA 92807
Phone (714) 279-6088

23781 Maquina
Mission Viejo, CA 92691
Phone (949) 455-4272

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1629043054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23781 MAQUINA AVE.",
            "address_2": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926912716",
            "telephone_number": "412-965-7204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23781 MAQUINA AVE.",
            "address_2": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926912716",
            "telephone_number": "412-965-7204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROFAGHA SAJJADIAN",
        "first_name": "RANA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-21",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A-95792",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101351003",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "RANA",
            "last_name": "ROFAGHA",
            "prefix": "DR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.