Individual provider Active NPI

Eshagh Ezra, M.D.

  • Family Medicine Physician
  • North Hills, CA
National Provider Identifier
1790797835
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A56249 Issued in CA
Practice address
15424 Nordhoff St
Suite B
North Hills, CA 91343-6951
Phone
(818) 891-5500
Fax
(818) 891-5505
NPI assigned
Aug 13, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A56249 CA Primary

Addresses

Primary practice location

15424 Nordhoff St
Suite B
North Hills, CA 91343-6951

Mailing address

22716 Paul Revere Dr
Calabasas, CA 91302-4812
Phone (818) 891-5500

Other identifiers 1

IdentifierTypeStateIssuer
00A562490MedicaidCA

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
I20050511000414 CA Practitioner - General PracticePractitioner - Internal Medicine 3971543794 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General PracticeAlso: Internal Medicine
Education
Other, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

18433 Roscoe Blvd
Suite 202
Northridge, CA 91325-4134
Phone (818) 891-5500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A56249CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eshagh Ezra M.D., Inc. Family Medicine CurrentSince Mar 1, 2005 Accepting new patients
Valley Presbyterian Hospital Past Accepting new patients
Cha Hollywood Medical Center, LP Past Accepting new patients

Locations

15424 Nordhoff St
Ste B
North Hills, CA 91343
Phone (818) 292-2719

18433 Roscoe Blvd
Ste 202
Northridge, CA 91325
Phone (818) 349-1262

3095 Old Conejo Rd
Ste 201
Thousand Oaks, CA 91320
Phone (818) 891-5500

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1790797835",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22716 PAUL REVERE DR",
            "city": "CALABASAS",
            "state": "CA",
            "postal_code": "913024812",
            "telephone_number": "818-891-5500",
            "fax_number": "818-891-5505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15424 NORDHOFF ST",
            "address_2": "SUITE B",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913436951",
            "telephone_number": "818-891-5500",
            "fax_number": "818-891-5505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EZRA",
        "first_name": "ESHAGH",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A56249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A562490",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Hills, CA

Sources for this page

Verify at the official NPI Registry.