Mastaneh Nikravesh, MD is a medicare enrolled "Preventive Medicine - Addiction Medicine" physician in Hemet, California. Her current practice location is
1117 E Devonshire Ave Ste 209, Hemet, California. You can reach out to her office (for appointments etc.) via phone at
(951) 925-6389.
Mastaneh Nikravesh is licensed to practice in Wisconsin (license number 84692) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1508429143.
Physician's Profile
| Full Name | Mastaneh Nikravesh |
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| Gender | Female |
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| Speciality | Preventive Medicine - Addiction Medicine |
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| Location | 1117 E Devonshire Ave Ste 209, Hemet, 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: 1508429143
- Provider Enumeration Date: 04/18/2019
- Last Update Date: 11/25/2024
Medicare PECOS Information:
- PECOS PAC ID: 2961863881
- Enrollment ID: I20241205002015
Medical Identifiers
Medical identifiers for Mastaneh Nikravesh such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1508429143 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 2083A0300X | Preventive Medicine - Addiction Medicine | 84692 (Wisconsin) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | 84692 (Wisconsin) | Secondary |
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. Mastaneh Nikravesh allows following entities to bill medicare on her behalf.
| Entity Name | Gundersen Lutheran Medical Center Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1225873458
PECOS PAC ID: 2163331414
Enrollment ID: O20130619000254 |
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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. Mastaneh Nikravesh 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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Mastaneh Nikravesh, MD
6629 Dwane Ave,
San Diego, CA 92120-3928
Ph: () - | Mastaneh Nikravesh, MD
1117 E Devonshire Ave Ste 209,
Hemet, CA 92543-3083
Ph: (951) 925-6389 |
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