Individual provider Active NPI

Hessam Mahdavi, MD

  • Internal Medicine Physician
  • Rancho Mirage, CA
National Provider Identifier
1851393300
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
C52222 Issued in CA
Practice address
70390 Highway 111 Ste 106
Rancho Mirage, CA 92270-5107
Phone
(760) 674-3818
Fax
(760) 773-4167
NPI assigned
Aug 15, 2005
Last updated
May 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X C52222 CA Primary

Addresses

Primary practice location

70390 Highway 111 Ste 106
Rancho Mirage, CA 92270-5107

Mailing address

78120 Wildcat Dr
Palm Desert, CA 92211-1140
Phone (760) 340-2682

Other practice location 1

39000 Bob Hope Dr
Rancho Mirage, CA 92270-3221
Phone (760) 340-3911

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
I20100504000025 CA Practitioner - Internal Medicine 4183519432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palm Desert Radiology Medical Group IncGroup PAC ID 0749173789, 125 clinicians

Practice addresses (Care Compare)

70380 Hwy 111
Rancho Mirage, CA 92270-3060
Phone (760) 674-3850

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.08 of 100Reported as group
Quality
81.28
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C52222CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Palm Desert Radiology Medical Group, Inc CurrentSince Jun 1, 2023 Accepting new patients
Eisenhower Medical Center Past Accepting new patients
Decatur Vein Clinic, Michigan, PC Past Accepting new patients
Spectrum Health Hospitals Past Accepting new patients

Locations

39000 Bob Hope Dr
Rancho Mirage, CA 92270
Phone (760) 340-3911

39000 Bob Hope Dr
Ofc
Rancho Mirage, CA 92270
Phone (760) 333-1813

70380 Highway 111
Rancho Mirage, CA 92270

70390 Highway 111
Ste 106
Rancho Mirage, CA 92270
Phone (760) 674-3818

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.

Hospital & facility affiliations 1

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": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1851393300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "78120 WILDCAT DR",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922111140",
            "telephone_number": "760-340-2682",
            "fax_number": "760-773-9695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "70390 HIGHWAY 111 STE 106",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922705107",
            "telephone_number": "760-674-3818",
            "fax_number": "760-773-4167"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39000 Bob Hope Dr",
            "address_purpose": "LOCATION",
            "city": "Rancho Mirage",
            "state": "CA",
            "postal_code": "922703221",
            "country_code": "US",
            "telephone_number": "760-340-3911",
            "fax_number": "760-773-9695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAHDAVI",
        "first_name": "HESSAM",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C52222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

Verify at the official NPI Registry.