NPIMap

Organization Active NPI

Agoura Family Practice Associates

  • Family Medicine Physician
  • Thousand Oaks, CA
National Provider Identifier
1912960345
Registry record updated Jun 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G069473 Issued in CA
Legal business name
AGOURA FAMILY PRACTICE ASSOCIATES
Practice address
3180 Willow LN
102
Thousand Oaks, CA 91361-4900
Phone
(805) 494-8520
Fax
(805) 557-0196
NPI assigned
Apr 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2009

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

Authorized official

Name
Dr. Bader Iqbal, MDNPI 1346254364
Title
Owner Partner
Phone
(805) 494-8520

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X G069473 CA Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X A67631 CA

Addresses

Primary practice location

3180 Willow LN
102
Thousand Oaks, CA 91361-4900

Mailing address

3180 Willow LN
#102
Thousand Oaks, CA 91361-4900
Phone (805) 494-8520

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090618000067 CA Part B Supplier - Clinic/Group Practice 7214087949 Receives reassigned benefits from 3 practitioners
Practice locations: Thousand Oaks, CA

National Provider Directory

National Provider Directory
Tax ID family
Agoura Fam Prac2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

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)…

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245888000000",
    "number": "1912960345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3180 WILLOW LN",
            "address_2": "#102",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913614900",
            "telephone_number": "805-494-8520",
            "fax_number": "805-557-0196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 WILLOW LN",
            "address_2": "102",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913614900",
            "telephone_number": "805-494-8520",
            "fax_number": "805-557-0196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGOURA FAMILY PRACTICE ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-07",
        "last_updated": "2009-06-25",
        "status": "A",
        "authorized_official_last_name": "IQBAL",
        "authorized_official_first_name": "BADER",
        "authorized_official_title_or_position": "OWNER PARTNER",
        "authorized_official_telephone_number": "805-494-8520",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G069473",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A67631",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; 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.