California Institute for Cardiovascular and Laser Vein Surg

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

A060777 Issued in CA

Legal business name

CALIFORNIA INSTITUTE FOR CARDIOVASCULAR AND LASER VEIN SURG

Practice address

16030 Ventura Blvd Ste 605
Encino, CA 91436-4471

Phone

(818) 422-5322

Fax

(818) 578-8476

NPI assigned

Feb 12, 2011

Last updated

Apr 29, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Sam Ebrahimi, M.D.NPI 1114916376

Title

Owner

Phone

(818) 422-5322

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 4

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.

• Sam A Ebrahimi, MD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Tarzana, CA
  • NPI 1114916376
  Medicare reassignment Authorized official
• Normand Miller, MD

  • Vascular Surgery Physician
  • Salem, NH
  • NPI 1225099518

  CA

  Medicare reassignment NPD
• Hasmig Darakian, PA-C

  • Physician Assistant
  • Los Angeles, CA
  • NPI 1689928541
  Medicare reassignment
• Maryam Hassanpour, D.O.

  • Internal Medicine Physician
  • San Jose, CA
  • NPI 1154742831
  Medicare reassignment

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

{
    "created_epoch": "1297468800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461888000000",
    "number": "1891092797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18375 VENTURA BLVD # 404",
            "city": "TARZANA",
            "state": "CA",
            "postal_code": "913564218",
            "telephone_number": "818-422-5322",
            "fax_number": "818-578-8476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16030 VENTURA BLVD STE 605",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914364471",
            "telephone_number": "818-422-5322",
            "fax_number": "818-578-8476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA INSTITUTE FOR CARDIOVASCULAR AND LASER VEIN SURG",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-12",
        "last_updated": "2016-04-29",
        "status": "A",
        "authorized_official_last_name": "EBRAHIMI",
        "authorized_official_first_name": "SAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-422-5322",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "A060777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "404465702",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "035556900",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• California Center for Healthy Living
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• California Hand Center, Inc.
• California Healthcare Management Group, Inc
• California Industrial Laboraties, Inc
• California Institute for CV&LVS
• California Orthopedics and Sports Medicine Associates (COSMA Management Services)
• California Outpatient Anesthesia Specialists Team, Inc.,
• California Psychological Associates
• California Rehabilitation & Sports Therapy (California Hand Therapy)

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Encino, CA
• Providers in Encino, CA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2016; 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.