Pacific Interventional Vascular Access Center Medical Corporation

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

Legal business name

PACIFIC INTERVENTIONAL VASCULAR ACCESS CENTER MEDICAL CORPORATION

Doing business as

Pacific Interventional Vascular Access Center

Practice address

6076 Bristol Pkwy Ste 108
Culver City, CA 90230-6600

Phone

(310) 348-9604

NPI assigned

May 24, 2011

Organization subpart

No

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

Authorized official

Name

Spencer Brown, MDNPI 1124210018

Title

Authorized Official

Phone

(310) 348-9604

Specialties & licenses 3

Addresses

Other names 2

• Pacific Interventional Vascular Access Center Doing business as
• Brown and Tabibian, A Medical Corporation Former legal business name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Pivac ASC LLC

  • Ambulatory Surgical Clinic/Center
  • Culver City, CA
  • NPI 1679010417

  Member Of

  NPD member

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 5

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

• Spencer Leland Brown, M.D.

  • Vascular Surgery Physician
  • Los Angeles, CA
  • NPI 1124210018
  Medicare reassignment NPD Authorized official
• Kamran Karimi, M.D.

  • Nephrology Physician
  • Los Angeles, CA
  • NPI 1730470220
  Medicare reassignment NPD
• Anthony D Becker, MD

  • Vascular & Interventional Radiology Physician
  • Bellflower, CA
  • NPI 1770510760
  NPD (past)
• Philip W Chung, M.D.

  • Nephrology Physician
  • Torrance, CA
  • NPI 1003881889
  NPD (past)
• Deacon Emmet Farrell, M.D

  • Pain Medicine (Anesthesiology) Physician
  • West Hollywood, CA
  • NPI 1467837377
  NPD (past)

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

{
    "created_epoch": "1306195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1942593918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 VALLEY STREAM PKWY",
            "address_2": "SUITE 100",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193551407",
            "telephone_number": "610-644-8900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6076 BRISTOL PKWY STE 108",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902306600",
            "telephone_number": "310-348-9604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC INTERVENTIONAL VASCULAR ACCESS CENTER MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-24",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "310-348-9604",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Interventional Vascular Access Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pacific Interventional Vascular Access Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Brown and Tabibian, A Medical Corporation",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Nkem Linda Ozoagu
• Jasmine Jesica Pacheco Galvez
• Julissa Pacheco-Pena
• Tanagon Micke Pacheco
• Pacific Coast Community Acupuncture
• Jaime Padilla Jr.
• Jose Antonio Padilla
• Arianne Lambino Paez
• Robert Joe Page III
• Patrick Paige

• Vascular & Interventional Radiology Physician in Culver City, CA
• Providers in Culver City, CA by specialty
• Vascular & Interventional Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.