Active NPI
Andre Panossian, M.D.
- Plastic Surgery Physician
- Pasadena, CA
National Provider Identifier
1710177845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- A76052
- Practice address
- 39 Congress St Ste 402
Pasadena, CA 91105-3024 - Phone
- (800) 958-3778
- Fax
- (800) 958-3778
- NPI assigned
- Jul 25, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | A76052 | CA | Primary |
Addresses
Primary practice location
39 Congress St Ste 402
Pasadena, CA 91105-3024
Mailing address
39 Congress St Ste 402
Pasadena, CA 91105-3024
Phone (800) 958-3778
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A760520 | Other | CA | BLUE SHIELD # |
| 1710177845 | Medicaid | CA |
Other names 1
- Andre A Panossian
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Nov 20, 2018 through Nov 20, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76052 | CA | MD | Clinical Social Worker |
| A76052 | CA | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1185321600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568505600000",
"number": "1710177845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "39 CONGRESS ST STE 402",
"city": "PASADENA",
"state": "CA",
"postal_code": "911053024",
"telephone_number": "800-958-3778",
"fax_number": "800-958-3778"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "39 CONGRESS ST STE 402",
"city": "PASADENA",
"state": "CA",
"postal_code": "911053024",
"telephone_number": "800-958-3778",
"fax_number": "800-958-3778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PANOSSIAN",
"first_name": "ANDRE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-25",
"last_updated": "2019-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "CA",
"license": "A76052",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD #",
"identifier": "00A760520",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1710177845",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "ANDRE",
"last_name": "PANOSSIAN",
"middle_name": "A",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Pasadena, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.