NPIMap

Organization Active NPI

Shahbaz Farnad MD Professional Corporation

Doing business as Miracle Mile Medical Group

  • Multi-Specialty Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1871078972
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SHAHBAZ FARNAD MD PROFESSIONAL CORPORATION
Doing business as
Miracle Mile Medical Group
Practice address
5757 Wilshire Blvd
Promenade 2
Los Angeles, CA 90036
Phone
(310) 383-1400
NPI assigned
Sep 25, 2018
Last updated
May 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Authorized official

Name
Dr. Shahbaz Farnad, MDNPI 1992080618
Title
Owner
Phone
(310) 383-1400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X
Otolaryngology Physician 207Y00000X
Interventional Pain Medicine Physician 208VP0014X
Multi-Specialty Clinic/Center 261QM1300X Primary
Medical Physician Assistant 363AM0700X
Surgical Physician Assistant 363AS0400X

Addresses

Primary practice location

5757 Wilshire Blvd
Promenade 2
Los Angeles, CA 90036

Mailing address

5757 Wilshire Blvd
Promenade 2
Los Angeles, CA 90036
Phone (310) 383-1400

Other names 1

  • Miracle Mile Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181116001669 CA Part B Supplier - Clinic/Group Practice 0446504096 Receives reassigned benefits from 9 practitioners
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1537833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715299200000",
    "number": "1871078972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5757 WILSHIRE BLVD",
            "address_2": "PROMENADE 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90036",
            "telephone_number": "310-383-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5757 WILSHIRE BLVD",
            "address_2": "PROMENADE 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90036",
            "telephone_number": "310-383-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHAHBAZ FARNAD MD PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-25",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A",
        "authorized_official_last_name": "FARNAD",
        "authorized_official_first_name": "SHAHBAZ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-383-1400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Miracle Mile Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.