Individual provider Active NPI

Behnaz Babaknia, PA-C

  • Physician Assistant
  • Fountain Valley, CA
National Provider Identifier
1992275093
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
56017 Issued in CA
Practice address
17360 Brookhurst St
Fountain Valley, CA 92708-3720
Phone
(657) 241-3750
NPI assigned
Nov 30, 2018
Last updated
Jan 25, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 56017 CA Primary

Addresses

Primary practice location

17360 Brookhurst St
Fountain Valley, CA 92708-3720

Mailing address

17360 Brookhurst St
Fountain Valley, CA 92708-3720

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190326000035 CA Practitioner - Physician Assistant 8022358266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Nova Southeastern Univ College of Dental Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

11420 Warner Ave
Fountain Valley, CA 92708-2529
Phone (714) 549-1300

14150 Culver Dr
Suite 100
Irvine, CA 92604-0322
Phone (949) 552-4584

15464 Goldenwest St
Westminster, CA 92683-6149
Phone (714) 891-9008

18111 Brookhurst St
Suite 6100
Fountain Valley, CA 92708-6728
Phone (714) 378-7330

2110 N Bellflower Blvd
Long Beach, CA 90815-3126
Phone (562) 346-2222

4950 Barranca Pkwy
Suite 104
Irvine, CA 92604-8644
Phone (949) 857-1248

722 Baker St
Costa Mesa, CA 92626-4320
Phone (714) 557-6300

9122 Adams Ave
Huntington Beach, CA 92646-3405
Phone (714) 378-0900

Merit-based Incentive Payment System (MIPS)

Final score
87.17 of 100Reported as group
Quality
81.15
Promoting interoperability
100
Improvement activities
40
Cost
71.64

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
56017CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bristol Park Medical Group, Inc Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1543536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548374400000",
    "number": "1992275093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720",
            "telephone_number": "657-241-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BABAKNIA",
        "first_name": "BEHNAZ",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-30",
        "last_updated": "2019-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "56017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

Verify at the official NPI Registry.