Individual provider Active NPI

Mansoor Azim, M.D.

  • Nephrology Physician
  • Los Angeles, CA
National Provider Identifier
1942567540
Registry record updated Feb 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A128143 Issued in CA
Practice address
3770 Keystone Ave Apt 107
Los Angeles, CA 90034-6340
Phone
(951) 961-8639
NPI assigned
Apr 19, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 7, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A128143 CA
Nephrology Physician 207RN0300X A128143 CA Primary

Addresses

Primary practice location

3770 Keystone Ave Apt 107
Los Angeles, CA 90034-6340

Mailing address

3770 Keystone Ave Apt 107
Los Angeles, CA 90034-6340
Phone (951) 961-8639

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170726003523 CA Practitioner - NephrologyPractitioner - Internal Medicine 8628348463 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Faculty Physicians and Surgeons of LlusmGroup PAC ID 1153227814, 1,313 clinicians

Practice addresses (Care Compare)

11234 Anderson St
Loma Linda, CA 92354-2804

25845 Barton Rd
Suite F
Loma Linda, CA 92354-3899
Phone (909) 558-2828

Hospital & facility affiliations

  • Loma Linda University Medical Center Hospital, Loma Linda, CA, CCN 050327

Merit-based Incentive Payment System (MIPS)

Final score
88.87 of 100Reported as group
Quality
72.13
Promoting interoperability
80
Improvement activities
40
Cost
77.36

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A128143CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Faculty Physicians and Surgeons of Llusm Current Accepting new patients
Faculty Physicians and Surgeons of Llusm CurrentSince Aug 8, 2017 Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients
Faculty Physicians and Surgeons of Llusm Past Accepting new patients

Locations

11234 Anderson St
#A600
Loma Linda, CA 92350
Phone (909) 558-2824

File Number 54701
Los Angeles, CA 90074
Phone (909) 651-4300

Interoperability endpoints

  • Direct secure messaging: mazim136864@direct.llu.edu

Organizations & group practices 4

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 1

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": "1334793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517961600000",
    "number": "1942567540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3770 KEYSTONE AVE APT 107",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900346340",
            "telephone_number": "951-961-8639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3770 KEYSTONE AVE APT 107",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900346340",
            "telephone_number": "951-961-8639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AZIM",
        "first_name": "MANSOOR",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-19",
        "last_updated": "2018-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A128143",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A128143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.