Active NPI
Khodam-Rad Payman, M.D.
- Specialist
- Encino, CA
National Provider Identifier
1841392610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- A75190
- Practice address
- 17525 Ventura Blvd
Suite 203
Encino, CA 91316-3843 - Phone
- (818) 986-0200
- Fax
- (818) 986-4393
- NPI assigned
- Sep 2, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | A75190 | CA | Primary |
Addresses
Primary practice location
17525 Ventura Blvd
Suite 203
Encino, CA 91316-3843
Mailing address
17525 Ventura Blvd
Suite 203
Encino, CA 91316-3843
Phone (818) 986-0200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A75190 | Other | CA | CA LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jan 1, 2014 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A75190 | CA | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Khodamrad Payman, M.D., Inc. | Past | Accepting new patients | |
| Boulevard Surgicenter, Inc. | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Orthopaedic Surgery of the Spine Physician
- Encino, CA
- NPI 1629265434
-
- Ambulatory Surgical Clinic/Center
- Encino, CA
- NPI 1861504037
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1157155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222041600000",
"number": "1841392610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17525 VENTURA BLVD",
"address_2": "SUITE 203",
"city": "ENCINO",
"state": "CA",
"postal_code": "913163843",
"telephone_number": "818-986-0200",
"fax_number": "818-986-4393"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17525 VENTURA BLVD",
"address_2": "SUITE 203",
"city": "ENCINO",
"state": "CA",
"postal_code": "913163843",
"telephone_number": "818-986-0200",
"fax_number": "818-986-4393"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAYMAN",
"first_name": "KHODAM-RAD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-02",
"last_updated": "2008-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "A75190",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CA LICENSE",
"identifier": "A75190",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2008; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.