Individual provider Active NPI

Evans Phung Tran, PA

  • Physician Assistant
  • Los Alamitos, CA
National Provider Identifier
1750632253
Registry record updated Mar 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1106874 Issued in CA
Practice address
3801 Katella Ave
Suite 110
Los Alamitos, CA 90720-3338
Phone
(562) 594-0860
Fax
(562) 594-9010
NPI assigned
Sep 24, 2012
Last updated
Mar 13, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1106874 CA Primary

Addresses

Primary practice location

3801 Katella Ave
Suite 110
Los Alamitos, CA 90720-3338

Mailing address

3801 Katella Ave
Suite 110
Los Alamitos, CA 90720-3338
Phone (562) 594-0860

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130308000227 CA Practitioner - Physician Assistant 7719132133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Healthcare Partners PCGroup PAC ID 2163606807, 232 clinicians

Practice addresses (Care Compare)

23600 Telo Ave
Suite 220
Torrance, CA 90505-4039
Phone (310) 534-8400

3801 Katella Ave
Suite 223
Los Alamitos, CA 90720-6904
Phone (562) 499-4183

3801 Katella Ave
Suite 302
Los Alamitos, CA 90720-3374
Phone (562) 449-4183

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
22614CAMDGeneral Practice Dentistry
1106874CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Skyline Urology Current Accepting new patients
Paletz Agatstein Urology Medical GRP Inc CurrentSince Oct 1, 2002 Accepting new patients
Urology Institute of the South Bay Current Accepting new patients

Locations

575 E Hardy St
Ste 215
Inglewood, CA 90301
Phone (310) 673-3333

3801 Katella Ave
Ste 223
Los Alamitos, CA 90720
Phone (562) 449-4183

20911 Earl St
Ste 140
Torrance, CA 90503
Phone (310) 542-0199

23600 Telo Ave
Ste 220
Torrance, CA 90505
Phone (310) 534-8400

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: evans.tran.1@3663.direct.athenahealth.com

Organizations & group practices 4

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 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": "1348444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363132800000",
    "number": "1750632253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 KATELLA AVE",
            "address_2": "SUITE 110",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203338",
            "telephone_number": "562-594-0860",
            "fax_number": "562-594-9010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 KATELLA AVE",
            "address_2": "SUITE 110",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907203338",
            "telephone_number": "562-594-0860",
            "fax_number": "562-594-9010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAN",
        "first_name": "EVANS",
        "middle_name": "PHUNG",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-24",
        "last_updated": "2013-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "1106874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Alamitos, CA

Sources for this page

Verify at the official NPI Registry.