NPIMap

Individual provider Active NPI

Sam F Daneshvari, M.D.

  • Nephrology Physician
  • Glendale, CA
National Provider Identifier
1851496145
Registry record updated Sep 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A60891 Issued in CA
Practice address
1505 Wilson Ter
Suite #155
Glendale, CA 91206-4071
Phone
(818) 500-4055
Fax
(818) 500-4065
NPI assigned
Sep 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A60891 CA Primary

Addresses

Primary practice location

1505 Wilson Ter
Suite #155
Glendale, CA 91206-4071

Mailing address

1505 Wilson Ter
Suite #155
Glendale, CA 91206-4071
Phone (818) 500-4055

Other identifiers 1

IdentifierTypeStateIssuer
00A608910MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101110001251 CA Practitioner - Nephrology 4688776321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of Southern California Keck School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Disease Medical Group IncGroup PAC ID 3173542198, 8 clinicians

Practice addresses (Care Compare)

1505 Wilson Ter
Suite 155
Glendale, CA 91206-4032
Phone (818) 500-4055

Hospital & facility affiliations

  • DaVita North Glendale Dialysis Dialysis facility, Glendale, CA, CCN 552589
  • Glendale Adventist Medical Center Hospital, Glendale, CA, CCN 050239
  • Usc Verdugo Hills Hospital Hospital, Glendale, CA, CCN 050124
  • Hollywood Presbyterian Medical Center Hospital, Los Angeles, CA, CCN 050063
  • Glendale Mem Hospital & HLTH Center Hospital, Glendale, CA, CCN 050058
  • Northridge Hospital Medical Center Hospital, Northridge, CA, CCN 050116

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A60891CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Disease Medical Group Inc CurrentSince Jan 15, 2001 Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients
Cha Hollywood Medical Center, LP Past Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Dialysis Inc. PastSince Jan 15, 2007 Accepting new patients
Dignity Health Past Accepting new patients

Locations

1505 Wilson Ter
Ste 155
Glendale, CA 91206
Phone (818) 500-4055

1500 S Central Ave
Ste 300
Glendale, CA 91204
Phone (818) 242-0475

4835 Van Nuys Blvd
Ste 111
Van Nuys, CA 91403
Phone (818) 617-9840

1540 W West Covina Pkwy
West Covina, CA 91790
Phone (626) 337-8007

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: sam.daneshvari.1@15679.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15679/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409616000000",
    "number": "1851496145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 WILSON TER",
            "address_2": "SUITE #155",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064071",
            "telephone_number": "818-500-4055",
            "fax_number": "818-500-4065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 WILSON TER",
            "address_2": "SUITE #155",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064071",
            "telephone_number": "818-500-4055",
            "fax_number": "818-500-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DANESHVARI",
        "first_name": "SAM",
        "middle_name": "F",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2014-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A60891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A608910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.