NPIMap

Individual provider Active NPI

Jacob Jacque Ahdoot, M.D.

  • Nephrology Physician
  • Los Angeles, CA
National Provider Identifier
1689878852
Registry record updated May 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A98763 Issued in CA
Practice address
1700 E Cesar E Chavez Ave
Suite 3750
Los Angeles, CA 90033-2424
Phone
(323) 250-2680
Fax
(323) 526-8305
NPI assigned
Jun 12, 2007
Last updated
May 13, 2014By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A98763 CA Primary

Addresses

Primary practice location

1700 E Cesar E Chavez Ave
Suite 3750
Los Angeles, CA 90033-2424

Mailing address

1700 E Cesar E Chavez Ave
Suite 3750
Los Angeles, CA 90033-2424
Phone (323) 250-2680

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
I20090303000360 CA Practitioner - NephrologyPractitioner - Internal Medicine 2961568753 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1711 W Temple St
Suite 1050
Los Angeles, CA 90026-5421
Phone (323) 250-2680

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A98763CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jacob Jacque Ahdoot MD a Professional Corporation Nephrology CurrentSince Apr 2, 2011 Accepting new patients
White Memorial Medical Center Past Accepting new patients
White Memorial Medical Group, Inc. PastSince Apr 1, 1994 Accepting new patients
Rai Care Centers of Southern California I, LLC PastSince Jul 14, 2011 Accepting new patients
White Memorial Medical Group, Inc. Past Accepting new patients

Locations

1700 E Cesar E Chavez Ave
Ste 3750
Los Angeles, CA 90033
Phone (323) 221-1302

1711 W Temple St
Ste 1050
Los Angeles, CA 90026
Phone (323) 250-2680

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399939200000",
    "number": "1689878852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 E CESAR E CHAVEZ AVE",
            "address_2": "SUITE 3750",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332424",
            "telephone_number": "323-250-2680",
            "fax_number": "323-526-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E CESAR E CHAVEZ AVE",
            "address_2": "SUITE 3750",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332424",
            "telephone_number": "323-250-2680",
            "fax_number": "323-526-8305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AHDOOT",
        "first_name": "JACOB",
        "middle_name": "JACQUE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2014-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A98763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.