Active NPI
Puja Shahrouki, MD
- Diagnostic Radiology Physician
- Thousand Oaks, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- License
- A173721
- Practice address
- 100 Moody CT Ste 200
Thousand Oaks, CA 91360-6082 - Phone
- (310) 301-6800
- NPI assigned
- May 23, 2018
- Last updated
- Jul 11, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 276542 | MA | |
| Diagnostic Radiology Physician | 2085R0202X | A173721 | CA | Primary |
Addresses
Primary practice location
100 Moody CT Ste 200
Thousand Oaks, CA 91360-6082
Mailing address
5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Other practice location 1
115 Lincoln St
Framingham, MA 01702-6342
Phone (508) 383-1000
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
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 93.78 of 100
- Quality
- 80.38
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 81.13 of 100
- Quality
- 62.91
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 68.15
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 276542 | MA | MD | Internal Medicine Physician |
| A173721 | CA | MD | Diagnostic Radiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Martin Luther King Jr Community Medical Foundation | Current | Accepting new patients | |
| Martin Luther King Jr Community Medical Foundation | Internal Medicine | Current | Accepting new patients |
| UCLA Medical Group | Internal Medicine | Past | Accepting new patients |
| Regents Univ of Calif Los Angeles | Past | Accepting new patients |
Locations
2215 W Rosecrans Ave
Ste 22
Compton, CA 90222
Phone (424) 529-6755
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.
-
dba Martin Lurher King Jr. Community Medical Group
- Multi-Specialty Clinic/Center
- Los Angeles, CA
- NPI 1356899777
Internal Medicine
-
- Radiology Clinic/Center
- Los Angeles, CA
- NPI 1346082294
-
dba Resnick Neuropsychiatric Hospital at UCLA
- Psychiatric Hospital
- Los Angeles, CA
- NPI 1952308363
-
- Internal Medicine Physician
- Los Angeles, CA
- NPI 1043427248
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1527033600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1689033600000",
"number": "1790276079",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5767 W CENTURY BLVD STE 400",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900455631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MOODY CT STE 200",
"city": "THOUSAND OAKS",
"state": "CA",
"postal_code": "913606082",
"telephone_number": "310-301-6800"
}
],
"practiceLocations": [
{
"address_1": "115 Lincoln St",
"address_purpose": "LOCATION",
"city": "Framingham",
"state": "MA",
"postal_code": "017026342",
"country_code": "US",
"telephone_number": "508-383-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SHAHROUKI",
"first_name": "PUJA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-05-23",
"last_updated": "2023-07-11",
"certification_date": "2023-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MA",
"license": "276542",
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "CA",
"license": "A173721",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Thousand Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.