Individual provider Active NPI

Hodad Naderi

  • Surgery Physician
  • Thousand Oaks, CA
National Provider Identifier
1770979502
Registry record updated Jul 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
1770979502 Issued in CA
Practice address
77 Rolling Oaks Dr Ste 203
Thousand Oaks, CA 91361-1019
Phone
(805) 379-9696
NPI assigned
Apr 8, 2015
Last updated
Jul 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 1770979502 CA Primary

Addresses

Primary practice location

77 Rolling Oaks Dr Ste 203
Thousand Oaks, CA 91361-1019

Mailing address

77 Rolling Oaks Dr Ste 203
Thousand Oaks, CA 91361-1019
Phone (805) 379-9696

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200825003402 CA Practitioner - General Surgery 1557640810 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of Iowa, RJ & L Carver College of Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5601 De Soto Ave
Woodland Hills, CA 91367-6701
Phone (818) 719-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1770979502CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oaks Surgical Specialists, a Medical Corporation Surgery CurrentSince Jul 1, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 6, 2022 Accepting new patients
Southern California Permanente Medical Group CurrentSince Jul 6, 2022 Accepting new patients
KND Development 59, LLC CurrentSince Aug 1, 2020 Accepting new patients
KND Development 59, LLC CurrentSince Aug 1, 2020 Accepting new patients
KND Development 59 LLC Current Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients

Locations

14900 Imperial Hwy
La Mirada, CA 90638
Phone (559) 627-6363

5525 W Slauson Ave
Los Angeles, CA 90056
Phone (310) 642-0325

18250 Roscoe Blvd
Ste 220
Northridge, CA 91325
Phone (818) 280-3901

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

1901 College Ave
Santa Ana, CA 92706
Phone (714) 564-7800

77 Rolling Oaks Dr
Ste 203
Thousand Oaks, CA 91361
Phone (805) 200-3946

888 S Hill Rd
Ventura, CA 93003
Phone (805) 477-6400

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 7

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 1

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": "1428451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1770979502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 ROLLING OAKS DR STE 203",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913611019",
            "telephone_number": "805-379-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 ROLLING OAKS DR STE 203",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913611019",
            "telephone_number": "805-379-9696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NADERI",
        "first_name": "HODAD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-08",
        "last_updated": "2022-07-25",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "1770979502",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

Verify at the official NPI Registry.