Individual provider Active NPI

Ivanna Natasha Maxson, MD

  • Pediatric Critical Care Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1821444571
Registry record updated Aug 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Critical Care Medicine PhysicianTaxonomy code 2080P0203X
License
S2110 Issued in TX
Practice address
200 UCLA Medical PLZ Ste 265
Los Angeles, CA 90095-2351
Phone
(310) 825-0867
Fax
(310) 794-5066
NPI assigned
May 12, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Critical Care Medicine Physician 2080P0203X S2110 TX Primary

Addresses

Primary practice location

200 UCLA Medical PLZ Ste 265
Los Angeles, CA 90095-2351

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 301-5631

Other practice location 1

6651 Main St
Houston, TX 77030-2351
Phone (832) 824-1000

Other practice location 2

1 Baylor Plz # Bcm320
Houston, TX 77030-3411
Phone (713) 798-4780

Other practice location 3

11234 Anderson St
Loma Linda, CA 92354-2804
Phone (909) 558-6131

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
I20230719002454 CA Practitioner - Critical Care (Intensivists)Practitioner - Pediatric Medicine 1759741911 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: Pediatric Medicine
Education
Loma Linda University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
UC RegentsGroup PAC ID 4587568829, 97 clinicians

Practice addresses (Care Compare)

10833 Le Conte Ave
Los Angeles, CA 90095-3075

10833 Leconte Ave
Los Angeles, CA 90095-3075
Phone (310) 825-9124

757 Westwood PLZ
Los Angeles, CA 90095-8358
Phone (310) 825-8021

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
S2110TXMDPediatric Critical Care Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
UC Regents Pediatric Critical Care Medicine CurrentSince Aug 1, 2023 Accepting new patients

Locations

200 UCLA Medical Plz
Ste 265
Los Angeles, CA 90095
Phone (310) 206-2429

File 2939
Los Angeles, CA 90074
Phone (310) 794-6596

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

10833 Le Conte Ave
#12311
Los Angeles, CA 90095
Phone (310) 825-9124

892 Aerovista Pl
Ste 210
San Luis Obispo, CA 93401
Phone (805) 549-8023

215 W Janss Rd
Thousand Oaks, CA 91360
Phone (805) 379-5435

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.

NPI Registry JSON

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

{
    "created_epoch": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693180800000",
    "number": "1821444571",
    "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",
            "telephone_number": "310-301-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 UCLA MEDICAL PLZ STE 265",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900952351",
            "telephone_number": "310-825-0867",
            "fax_number": "310-794-5066"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6651 Main St",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770302351",
            "country_code": "US",
            "telephone_number": "832-824-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Baylor Plz # Bcm320",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770303411",
            "country_code": "US",
            "telephone_number": "713-798-4780",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11234 Anderson St",
            "address_purpose": "LOCATION",
            "city": "Loma Linda",
            "state": "CA",
            "postal_code": "923542804",
            "country_code": "US",
            "telephone_number": "909-558-6131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAXSON",
        "first_name": "IVANNA",
        "middle_name": "NATASHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-12",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0203X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Critical Care Medicine",
            "state": "TX",
            "license": "S2110",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.