Individual provider Active NPI

Nicholas George Sakellariou, M.D.

  • Anesthesiology Physician
  • Burbank, CA
National Provider Identifier
1639190820
Registry record updated Jun 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A55530 Issued in CA
Practice address
501 S Buena Vista St
Burbank, CA 91505-4809
Phone
(818) 843-5111
Fax
(818) 847-3935
NPI assigned
Jul 22, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A55530 CA Primary

Addresses

Primary practice location

501 S Buena Vista St
Burbank, CA 91505-4809

Mailing address

PO Box 60790
Pasadena, CA 91116-6790
Phone (626) 795-6596

Other identifiers 2

IdentifierTypeStateIssuer
00A555300OtherCABLUE SHIELD
00A555300MedicaidCA

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
I20050913000661 CA Practitioner - Anesthesiology 7810920634 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
New York Medical College, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Buena Vista Anesthesia Medical GroupGroup PAC ID 7113975996, 51 clinicians

Practice addresses (Care Compare)

501 S Buena Vista St
Burbank, CA 91505-4866
Phone (818) 843-5111

Hospital & facility affiliations

  • Providence Saint Joseph Medical Ctr Hospital, Burbank, CA, CCN 050235
  • Providence Holy Cross Medical Center Hospital, Mission Hills, CA, CCN 050278

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A55530CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Buena Vista Anesthesia Medical Group Anesthesiology CurrentSince Feb 28, 2000 Accepting new patients

Locations

501 S Buena Vista St
Burbank, CA 91505
Phone (818) 783-0800

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

Organizations & group practices 1

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 2

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": "1153526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402617600000",
    "number": "1639190820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60790",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911166790",
            "telephone_number": "626-795-6596",
            "fax_number": "626-795-8247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S BUENA VISTA ST",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915054809",
            "telephone_number": "818-843-5111",
            "fax_number": "818-847-3935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAKELLARIOU",
        "first_name": "NICHOLAS",
        "middle_name": "GEORGE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-22",
        "last_updated": "2014-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A55530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A555300",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A555300",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burbank, CA

Sources for this page

Verify at the official NPI Registry.