NPIMap

Individual provider Active NPI

Jack Azad, M.D.

  • General Practice Physician
  • Los Angeles, CA
National Provider Identifier
1841489440
Registry record updated Jun 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A54433 Issued in CA
Practice address
11900 Avalon Blvd
#100
Los Angeles, CA 90061-2867
Phone
(323) 756-1317
Fax
(323) 756-4015
NPI assigned
Oct 18, 2007
Last updated
Jun 15, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X A54433 CA Primary

Addresses

Primary practice location

11900 Avalon Blvd
#100
Los Angeles, CA 90061-2867

Mailing address

11900 Avalon Blvd
#100
Los Angeles, CA 90061-2867
Phone (323) 756-1317

Other identifiers 2

IdentifierTypeStateIssuer
0A544334MedicaidCA
1891795613OtherCAGROUP/CORPORATION NPI #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1991
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

11900 S Avalon Blvd
Suite 100
Los Angeles, CA 90061-2867

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue2140
Removal of skin lesions1205
Removal of nail tissue110
Skin biopsy11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Illuminate Hospice Care Inc Current Accepting new patients
Intel Medical Group Inc CurrentSince Nov 7, 2017 Accepting new patients
West Coast Wound and Skin Care Inc CurrentSince Jun 8, 2020 Accepting new patients
Los Angeles County Department of Public Health Current Accepting new patients
Immediate Healthcare Clinic, Inc. CurrentSince Feb 1, 2016 Accepting new patients
Concierge Clinicians Inc CurrentSince Sep 28, 2023 Accepting new patients
Jack Azad,M.D.,Inc. General Practice CurrentSince Feb 1, 2006 Accepting new patients
Hope & Peace Hospice PastSince Oct 1, 2024 Accepting new patients
RBRK Healthcare LLC PastSince Oct 15, 2024 Accepting new patients
Universal Diagnostics Center, Inc Past Accepting new patients

Locations

2501 W Burbank Blvd
Ste 200
Burbank, CA 91505
Phone (818) 732-8272

1821 E Chapman Ave
Fullerton, CA 92831
Phone (714) 879-7301

10727 White Oak Ave
Ste 102
Granada Hills, CA 91344
Phone (818) 593-9140

10727 White Oak Ave
Ste 117
Granada Hills, CA 91344
Phone (818) 224-9390

11900 Avalon Blvd
Ste 100
Los Angeles, CA 90061
Phone (323) 756-1317

11900 Avalon Blvd
Ste 101
Los Angeles, CA 90061
Phone (310) 331-8134

11910 Avalon Blvd
Los Angeles, CA 90061
Phone (213) 756-1317

3615 E Imperial Hwy
Lynwood, CA 90262
Phone (310) 639-4623

11507 Oxnard St
Ste 3
North Hollywood, CA 91606
Phone (818) 508-3050

13330 Bloomfield Ave
Ste 209
Norwalk, CA 90650
Phone (562) 444-5441

13330 Bloomfield Ave
Unit 209
Norwalk, CA 90650
Phone (562) 513-2595

20301 Ventura Blvd
Ste 352
Woodland Hills, CA 91364
Phone (818) 593-9140

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/22283/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jackazad-pajocorporation@lacsapc.netsmartdirect.net

Organizations & group practices 12

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.

Hospital & facility affiliations 10

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": "1192665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497484800000",
    "number": "1841489440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11900 AVALON BLVD",
            "address_2": "#100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900612867",
            "telephone_number": "323-756-1317",
            "fax_number": "323-756-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11900 AVALON BLVD",
            "address_2": "#100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900612867",
            "telephone_number": "323-756-1317",
            "fax_number": "323-756-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZAD",
        "first_name": "JACK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-18",
        "last_updated": "2017-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A54433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0A544334",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP/CORPORATION NPI #",
            "identifier": "1891795613",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.

Verify at the official NPI Registry.