Individual provider Active NPI

Andrey Khalafian, MD

  • Psychiatry Physician
  • La Mesa, CA
National Provider Identifier
1780028183
Registry record updated Jun 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
A146799 Issued in CA
Practice address
5555 Grossmont Center Dr
La Mesa, CA 91942-3019
Phone
(619) 483-1657
Fax
(844) 367-4171
NPI assigned
Apr 29, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X A146799 CA Primary

Addresses

Primary practice location

5555 Grossmont Center Dr
La Mesa, CA 91942-3019

Mailing address

PO Box 516528
Los Angeles, CA 90051-0590
Phone (866) 284-2771

Other practice location 1

920 Sl Young Blvd
Oklahoma City, OK 73104-5036
Phone (405) 271-5251

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
I20170516002313 CA Practitioner - Psychiatry 1557660594 Reassigns benefits to 1 organization
Practice locations: La Mesa, CA

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Oklahoma College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergency and Acute Care Medical CorporationGroup PAC ID 9537108279, 431 clinicians

Practice addresses (Care Compare)

5555 Grossmont Ctr Dr
La Mesa, CA 91942-3019
Phone (619) 740-4800

Hospital & facility affiliations

  • Grossmont Hospital Hospital, La Mesa, CA, CCN 050026

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A146799CAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency and Acute Care Medical Corporation CurrentSince Aug 1, 2017 Accepting new patients

Locations

5555 Grossmont Center Dr
La Mesa, CA 91942
Phone (619) 465-0711

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

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": "1367193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1780028183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 516528",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900510590",
            "telephone_number": "866-284-2771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 GROSSMONT CENTER DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423019",
            "telephone_number": "619-483-1657",
            "fax_number": "844-367-4171"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 Sl Young Blvd",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731045036",
            "country_code": "US",
            "telephone_number": "405-271-5251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KHALAFIAN",
        "first_name": "ANDREY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-29",
        "last_updated": "2024-06-17",
        "certification_date": "2024-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CA",
            "license": "A146799",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.