NPIMap

Individual provider Active NPI

Jenanan Prakasha Vairavamurthy, MD

  • Vascular & Interventional Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1881919942
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
A136222 Issued in CA
Practice address
1500 San Pablo St FL 2
Los Angeles, CA 90033-5313
Phone
(323) 442-8541
NPI assigned
Apr 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Vascular & Interventional Radiology Physician 2085R0204X A136222 CA Primary

Addresses

Primary practice location

1500 San Pablo St FL 2
Los Angeles, CA 90033-5313

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-8541

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jenanan.vairavamurthy@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181030001289 CA Practitioner - Interventional RadiologyPractitioner - Diagnostic Radiology 1153619861 Reassigns benefits to 4 organizations
I20230727000650 NY Practitioner - Interventional Radiology 1153619861 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Interventional Radiology
Education
Albany Medical College of Union University, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Fpa Hospital BasedGroup PAC ID 4789826694, 423 clinicians

Practice addresses (Care Compare)

1176 5TH Ave
New York, NY 10029-6503
Phone (212) 241-8395

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
317938NYMDSchool Registered Nurse
A136222CAMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
John Muir Trauma Physicians Billing Service CurrentSince Feb 11, 2026 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Sep 22, 2018 Accepting new patients
Fpa Hospital Based Current Accepting new patients
Usc Care Medical Group, Inc CurrentSince Sep 22, 2018 Accepting new patients
Fpa Hospital Based CurrentSince Aug 1, 2023 Accepting new patients
Fpa Hospital Based CurrentSince Aug 1, 2023 Accepting new patients
John Muir Magnetic Imaging Center Past Accepting new patients
KC Tan, M.D. Medical Corporation Vascular & Interventional Radiology Past Accepting new patients
John Muir Call Coverage Medical Group, Inc. Past Accepting new patients

Locations

100 S Raymond Ave
Alhambra, CA 91801
Phone (626) 457-7938

2540 East St
Concord, CA 94520
Phone (925) 674-2228

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1500 San Pablo St
Fl 2
Los Angeles, CA 90033
Phone (323) 442-8541

525 N Garfield Ave
Monterey Park, CA 91754
Phone (626) 573-2222

438 W Las Tunas Dr
San Gabriel, CA 91776
Phone (626) 289-5454

1601 Ygnacio Valley Rd
Walnut Creek, CA 94598
Phone (925) 295-1545

3712 82nd St
Jackson Hts, NY 11372
Phone (718) 879-1600

1470 Madison Ave
New York, NY 10029
Phone (212) 241-0806

1176 5th Ave
New York, NY 10029
Phone (212) 241-6237

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Interoperability endpoints

  • Direct secure messaging: jenanan.vairavamurthy@direct.usc.edu

Organizations & group practices 11

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 8

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": "1270080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1881919942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-8541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SAN PABLO ST FL 2",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335313",
            "telephone_number": "323-442-8541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAIRAVAMURTHY",
        "first_name": "JENANAN",
        "middle_name": "PRAKASHA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-01",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": "A136222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jenanan.vairavamurthy@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1500 San Pablo St Fl 2",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.