Mr Mohammed Sufiyan Kagzi, LCSW is a medicare enrolled "Social Worker - Clinical" provider in Venice, California. His current practice location is
204 Hampton Dr, Venice, California. You can reach out to his office (for appointments etc.) via phone at
(310) 396-6468.
Mr Mohammed Sufiyan Kagzi is licensed to practice in California (license number 107568) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1366937757.
Healthcare Provider's Profile
| Full Name | Mr Mohammed Sufiyan Kagzi |
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| Gender | Male |
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| Speciality | Social Worker - Clinical |
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| Location | 204 Hampton Dr, Venice, California |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1366937757
- Provider Enumeration Date: 06/27/2018
- Last Update Date: 10/15/2024
Medicare PECOS Information:
- PECOS PAC ID: 5294278610
- Enrollment ID: I20240613002850
Medical Identifiers
Medical identifiers for Mr Mohammed Sufiyan Kagzi such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1366937757 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YM0800X | Counselor - Mental Health | 84502 (California) | Secondary |
| 171M00000X | Case Manager/care Coordinator | (* (Not Available)) | Secondary |
| 1041C0700X | Social Worker - Clinical | 107568 (California) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Mr Mohammed Sufiyan Kagzi allows following entities to bill medicare on his behalf.
| Entity Name | Providence Health & Services Washington |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1174744304
PECOS PAC ID: 6709782600
Enrollment ID: O20190122000790 |
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| Entity Name | Providence Health & Services- Washington |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1124270715
PECOS PAC ID: 8325100480
Enrollment ID: O20190204000924 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Mohammed Sufiyan Kagzi is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Mr Mohammed Sufiyan Kagzi, LCSW
4153 Milton Ave,
Culver City, CA 90232-4054
Ph: (310) 954-7569 | Mr Mohammed Sufiyan Kagzi, LCSW
204 Hampton Dr,
Venice, CA 90291-2623
Ph: (310) 396-6468 |
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