NPIMap

Individual provider Active NPI

Reza Hosseini Dehkordi, MD

  • Hospitalist Physician
  • Mission Viejo, CA
National Provider Identifier
1679540116
Registry record updated Nov 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
C54677 Issued in CA
Practice address
26800 Crown Valley Pkwy
Suite 315
Mission Viejo, CA 92691-6384
Phone
(949) 364-6000
Fax
(949) 364-1204
NPI assigned
Mar 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2021

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 MD36414 WA
Hospitalist Physician 208M00000X C54677 CA Primary

Addresses

Primary practice location

26800 Crown Valley Pkwy
Suite 315
Mission Viejo, CA 92691-6384

Mailing address

26800 Crown Valley Pkwy Ste 315
Mission Viejo, CA 92691-8039
Phone (949) 364-6000

Other identifiers 1

IdentifierTypeStateIssuer
8250383MedicaidWA

Other names 1

  • Reza H Dehkordi Professional name

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
I20110817000614 CA Practitioner - Internal Medicine 0143257923 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Washington School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

1950 Sunny Crest Dr
Suite 2900
Fullerton, CA 92835-3641
Phone (714) 992-5350

27700 Medical Ctr Rd
Mission Viejo, CA 92691-6426
Phone (949) 364-1400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Upper gastrointestinal (GI) endoscopy for acid reflux1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
54677CAMDPharmacist
MD36414WAMDInternal Medicine Physician
C54677CAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Aug 1, 2013 Accepting new patients
Providence Medical Foundation Past Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Public Hospital District No 1 of Snohomish County Past Accepting new patients

Locations

200 W Ctr St Promenade
Ste 400
Anaheim, CA 92805

100 E Valencia Mesa Dr
Ste 105
Fullerton, CA 92835
Phone (714) 446-5200

1950 Sunny Crest Dr
Ste 2900
Fullerton, CA 92835

26800 Crown Valley Pkwy
Ste 315
Mission Viejo, CA 92691
Phone (949) 364-6001

26800 Crown Valley Pkwy
Ste 300
Mission Viejo, CA 92691

26800 Crown Valley Pkwy
Ste 305
Mission Viejo, CA 92691
Phone (949) 364-6001

27700 Medical Center Rd
Mission Viejo, CA 92691
Phone (949) 364-7744

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Providence Mission HospitalMission Viejo, CA, CCN 050567 Hospital Corporate Director Jan 1, 2020
Providence Mission HospitalLaguna Beach, CA, CCN 05S567 Hospital Corporate Director Jan 1, 2020
Providence Mission HospitalMission Viejo, CA, CCN 05T567 Hospital Corporate Director Jan 1, 2020
Providence Hospice Orange County SouthMission Viejo, CA, CCN 551658 Hospice Contracted Managing Employee Sep 1, 2021

Owned or controlled facilities with NPI records 5

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 4

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": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638230400000",
    "number": "1679540116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY STE 315",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918039",
            "telephone_number": "949-364-6000",
            "fax_number": "949-364-1204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26800 CROWN VALLEY PKWY",
            "address_2": "SUITE 315",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916384",
            "telephone_number": "949-364-6000",
            "fax_number": "949-364-1204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEHKORDI",
        "first_name": "REZA",
        "middle_name": "HOSSEINI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2021-11-30",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD36414",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "C54677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8250383",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "REZA",
            "last_name": "DEHKORDI",
            "middle_name": "H",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.