Tigran V Avakumov, MD
Individual provider Active NPI Anesthesiology Physician · Stockton, CA
NPI 1891724670 · NPPES record last updated Oct 9, 2007
Key facts
- NPI
- 1891724670
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- A84384 (CA)
- Practice address
- 2626 N California St
Suite G
Stockton, CA 95204-5500 - Phone
- (209) 464-9846
- Fax
- (209) 464-4082
- NPI assigned
- Jul 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Anesthesiology
- Education
- Sanford School of Medicine of University of South Dakota, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- South Tahoe Anesthesia Medical Group
Practice addresses (Care Compare)
2170 S Ave
South Lake Tahoe, CA 96150-7026
Phone (530) 541-3420
Hospital & facility affiliations
- Barton Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, NV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060822000646 | CA | Practitioner - Anesthesiology |
0446144612 | Reassigns benefits to 1 organization |
| I20090106000192 | NV | Practitioner - Anesthesiology | 0446144612 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A84384 | CA | MD | Pain Medicine (Anesthesiology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christopher J Garrett LTD | Pain Medicine | Past | Accepting new patients |
| Randall L Goode MD PC | Anesthesiology | Past | Accepting new patients |
| Delta Radiology, Inc. | Past | Accepting new patients | |
| Morpheus Anesthesia Inc | Anesthesiology | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | A84384 | CA | Yes |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | A84384 | CA |
Addresses
Primary practice location
2626 N California St
Suite G
Stockton, CA 95204-5500
Mailing address
2626 N California St
Suite G
Stockton, CA 95204-5500
Phone (209) 464-9846
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A843840 | Medicaid | CA |
Other providers in Stockton, CA
- Radin Aur
- Aura Surgery Center of Stockton LLC
- Garrett Austin
- Authority Vascular Surgery Incorporated
- Av Corp Inc
- Alanny D Avalos
- Jessica L Avalos
- Valerie Avalos
- Evony Michelle Avelar
- Natalie Avelar
All providers in Stockton, CA · Anesthesiology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.