NPIMap

Organization Active NPI

Kourosh Bagheri, M.D., M.S., a Professional Corporation

Doing business as Bagheri Medical Group

  • Internal Medicine Physician
  • Berkeley, CA
National Provider Identifier
1740367275
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G77496 Issued in CA
Legal business name
KOUROSH BAGHERI, M.D., M.S., A PROFESSIONAL CORPORATION
Doing business as
Bagheri Medical Group
Practice address
75 Parnassus Rd
Berkeley, CA 94708-2056
Phone
(805) 781-9111
Fax
(805) 285-4055
NPI assigned
Nov 1, 2006
Last updated
Oct 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Kourosh Darren Bagheri, MDNPI 1457540031
Title
MD/Owner
Phone
(805) 781-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X G77496 CA Primary

Addresses

Primary practice location

75 Parnassus Rd
Berkeley, CA 94708-2056

Mailing address

75 Parnassus Rd
Berkeley, CA 94708-2056
Phone (805) 781-9111

Other names 1

  • Bagheri Medical Group Doing business as

National Provider Directory

National Provider Directory

Locations

1177 Marsh St
Ste 100
San Luis Obispo, CA 93401
Phone (805) 434-2482

1575 Bishop St
San Luis Obispo, CA 93401
Phone (805) 225-8156

1194 Pacific St
Ste 100
Sn Luis Obisp, CA 93401
Phone (805) 458-2232

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1740367275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 PARNASSUS RD",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947082056",
            "telephone_number": "805-781-9111",
            "fax_number": "805-285-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 PARNASSUS RD",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947082056",
            "telephone_number": "805-781-9111",
            "fax_number": "805-285-4055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOUROSH BAGHERI, M.D., M.S., A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2023-10-10",
        "certification_date": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "BAGHERI",
        "authorized_official_first_name": "KOUROSH",
        "authorized_official_middle_name": "DARREN",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "805-781-9111",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G77496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bagheri Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bagheri Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.