Medprof Home Health Care, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

MEDPROF HOME HEALTH CARE, INC.

Practice address

7540 Balboa Blvd Ste 9
Van Nuys, CA 91406-2771

Phone

(818) 646-0143

NPI assigned

Jun 4, 2019

Organization subpart

No

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

Authorized official

Name

Kirstine Mikayelyan

Title

Ceo

Phone

(818) 646-0143

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Home health agency certification: CCN 559365

Legal name

MEDPROF HOME HEALTH CARE INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Jul 31, 2020

Last certification

Jul 31, 2020

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Apr 16, 2019 in CA

Enrollment address

11712 Moorpark St
Ste 203
Studio City, CA 91604-2163

Listed as

Medprof Home Health Care, IncCCN 559365

Overall star rating

4 of 5

Ownership

Proprietary

Certified

Jul 31, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Afshin Shawn Adhami, MD

  • Internal Medicine Physician
  • El Monte, CA
  • NPI 1104991686

  Home health agency

  Care Compare affiliation
• Lukchai Bhavabhutanon, D.O.

  • Internal Medicine Physician
  • Monterey Park, CA
  • NPI 1922032952

  Home health agency

  Care Compare affiliation
• Imanuel Khalili, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1447546627

  Home health agency

  Care Compare affiliation
• Kai En Tang, D.O

  • Family Medicine Physician
  • Los Angeles, CA
  • NPI 1841725686

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1559606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559606400000",
    "number": "1770141889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7540 BALBOA BLVD STE 9",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914062771",
            "telephone_number": "818-646-0143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7540 BALBOA BLVD STE 9",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914062771",
            "telephone_number": "818-646-0143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPROF HOME HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-04",
        "last_updated": "2019-06-04",
        "status": "A",
        "authorized_official_last_name": "MIKAYELYAN",
        "authorized_official_first_name": "KIRSTINE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-646-0143"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Van Nuys, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.