NPIMap

Individual provider Active NPI

Gevorg Ghazaryan, MD

  • Hospitalist Physician
  • Glendale, CA
National Provider Identifier
1629288329
Registry record updated Jun 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
A104857 Issued in CA
Practice address
1100 E Broadway Ste 205
Glendale, CA 91205-2490
Phone
(818) 453-5192
Fax
(818) 452-0716
NPI assigned
May 23, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A104857 CA
Hospitalist Physician 208M00000X A104857 CA Primary

Addresses

Primary practice location

1100 E Broadway Ste 205
Glendale, CA 91205-2490

Mailing address

1100 E Broadway Ste 205
Glendale, CA 91205-2490
Phone (818) 453-5192

Other identifiers 2

IdentifierTypeStateIssuer
BLUE SHIELDOtherCA0A1048570
A104857OtherCASTATE LICENSE

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
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090914000096 CA Practitioner - Internal Medicine 2567518772 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

1100 E Broadway
Suite 205
Glendale, CA 91205-2490
Phone (818) 453-5192

13652 Cantara St
Panorama City, CA 91402-5423
Phone (818) 375-2000

Hospital & facility affiliations

  • Caring 4 You Home Health Inc Home health agency, Burbank, CA, CCN 757020
  • Ana Home Health Inc Home health agency, Valley Village, CA, CCN 757773
  • Elysium Home Health Care Home health agency, Van Nuys, CA, CCN 559690
  • Healing Solutions Home Care Inc Home health agency, Van Nuys, CA, CCN 559464
  • Relieve Home Health Inc. Home health agency, Pasadena, CA, CCN 757997
  • Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382
  • Kaiser Foundation Hospital - Panorama City Hospital, Panorama City, CA, CCN 050137

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A104857CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince Feb 14, 2024 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Sutter Bay Medical Foundation Current Accepting new patients
Southern California Permanente Medical Group CurrentSince Feb 14, 2024 Accepting new patients
Ghazaryan MD Inc CurrentSince Jan 23, 2023 Accepting new patients
Eden Medical Center/San Leandro Hospital Campus Past Accepting new patients
Emanate Health Medical Center Past Accepting new patients

Locations

3200 Kearney St
Fremont, CA 94538
Phone (510) 498-2800

1100 E Broadway
Ste 205
Glendale, CA 91205
Phone (818) 453-5192

1110 E Broadway
Ste 205
Glendale, CA 91205

20103 Lake Chabot Rd
Hayward, CA 94546
Phone (510) 537-1234

3687 Mt Diablo Blvd
Ste 200
Lafayette, CA 94549
Phone (510) 204-6660

325 Distel Cir
Los Altos, CA 94022
Phone (510) 204-3977

12 Camino Encinas
Orinda, CA 94563
Phone (510) 204-8180

795 El Camino Real
#1112
Palo Alto, CA 94301

13652 Cantara St
Panorama City, CA 91402
Phone (818) 375-2417

13855 E 14th St
San Leandro, CA 94578
Phone (510) 357-6500

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717891200000",
    "number": "1629288329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 E BROADWAY STE 205",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912052490",
            "telephone_number": "818-453-5192",
            "fax_number": "818-452-0716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E BROADWAY STE 205",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912052490",
            "telephone_number": "818-453-5192",
            "fax_number": "818-452-0716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GHAZARYAN",
        "first_name": "GEVORG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-23",
        "last_updated": "2024-06-09",
        "certification_date": "2024-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A104857",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A104857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "0A1048570",
            "identifier": "BLUE SHIELD",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "A104857",
            "state": "CA"
        }
    ],
    "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": "13652 Cantara St",
            "city": "Panorama City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "914025423",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.