Individual provider Active NPI

Daniela Micic, M.D.

  • Anesthesiology Physician
  • Santa Monica, CA
National Provider Identifier
1962791053
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
A122430 Issued in CA
Practice address
2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone
(213) 840-8284
NPI assigned
Mar 29, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X A122430 CA Primary

Addresses

Primary practice location

2121 Santa Monica Blvd
Santa Monica, CA 90404

Mailing address

PO Box 60790
Pasadena, CA 91116-6790
Phone (626) 204-6747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160907002717 CA Practitioner - Anesthesiology 5395973499 Reassigns benefits to 2 organizations
I20191210000932 NV Practitioner - Anesthesiology 5395973499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Wisconsin School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fielden,Hanson,Isaacs,Miyada,Robison,Yeh LTDGroup PAC ID 5799683462, 168 clinicians

Practice addresses (Care Compare)

9127 W Russell Rd
Suite 110
Las Vegas, NV 89148-1253
Phone (702) 878-0700

Hospital & facility affiliations

  • Mountainview Hospital Hospital, Las Vegas, NV, CCN 290039

Merit-based Incentive Payment System (MIPS)

Final score
78.25 of 100Reported as group
Quality
74.41
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
122430CAMDClinical Social Worker
A122430CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fielden Hanson Isaacs Miyada Robison Yeh LTD Anesthesiology CurrentSince Oct 21, 2019 Accepting new patients
Bayside Anesthesia Medical Group CurrentSince Sep 1, 2016 Accepting new patients
South Bay Anesthesia Medical Group Inc. Anesthesiology CurrentSince Jan 29, 2018 Accepting new patients

Locations

2121 Santa Monica Blvd
Santa Monica, CA 90404
Phone (310) 281-2024

1328 22nd St
Santa Monica, CA 90404
Phone (310) 829-5511

4101 Torrance Blvd
Torrance, CA 90503
Phone (310) 540-7676

9127 W Russell Rd
Ste 110
Las Vegas, NV 89148
Phone (702) 209-2042

Organizations & group practices 3

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": "1301356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1962791053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60790",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911166790",
            "telephone_number": "626-204-6747",
            "fax_number": "626-396-0851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 SANTA MONICA BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "90404",
            "telephone_number": "213-840-8284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICIC",
        "first_name": "DANIELA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-29",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A122430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.