Modern Vascular Of Glendale, Llc - Medicare Primary Care in Glendale, AZ

Modern Vascular Of Glendale, Llc is a medicare enrolled primary clinic (Radiology - Vascular & Interventional Radiology) in Glendale, Arizona. The current practice location for Modern Vascular Of Glendale, Llc is 11851 N 51st Ave, Building G, Glendale, Arizona. For appointments, you can reach them via phone at (818) 949-2634. The mailing address for Modern Vascular Of Glendale, Llc is 26500 Agoura Rd Ste 102-587, Calabasas, California and phone number is (818) 880-8605.

Modern Vascular Of Glendale, Llc is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1063947638. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (818) 949-2634.

Contact Information

Modern Vascular Of Glendale, Llc
11851 N 51st Ave
Building G
Glendale
AZ 85304
(818) 949-2634
Not Available

Map and Direction


Primary Care Clinic Profile

Full NameModern Vascular Of Glendale, Llc
SpecialityRadiology
Location11851 N 51st Ave, Glendale, Arizona
Authorized Official Name and PositionYury Gampel (MANAGER)
Authorized Official Contact8188808605
Accepts Medicare InsuranceYes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Modern Vascular Of Glendale, Llc
26500 Agoura Rd Ste 102-587
Calabasas
CA 91302-1952

Ph: (818) 880-8605
Modern Vascular Of Glendale, Llc
11851 N 51st Ave
Building G
Glendale
AZ 85304

Ph: (818) 949-2634

NPI Details:

NPI Number1063947638
Provider Enumeration Date04/20/2017
Last Update Date07/11/2018

Medicare PECOS Information:

Medicare PECOS PAC ID3971875691
Medicare Enrollment IDO20170815004351

Medical Identifiers

Medical identifiers for Modern Vascular Of Glendale, Llc such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1063947638NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207Q00000XFamily Medicine (* (Not Available))Secondary
207RC0000XInternal Medicine - Cardiovascular Disease (* (Not Available))Secondary
207RI0011XInternal Medicine - Interventional Cardiology (* (Not Available))Secondary
2085R0204XRadiology - Vascular & Interventional Radiology (* (Not Available))Primary
213E00000XPodiatrist (* (Not Available))Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Modern Vascular Of Glendale, Llc acts as a billing entity for following providers:
Provider NameMarc L Eckhauser
Provider TypePractitioner - Vascular Surgery
Provider IdentifiersNPI Number: 1811997513
PECOS PAC ID: 2567362676
Enrollment ID: I20040113000443
Provider NameAnthony C Pozun
Provider TypePractitioner - Cardiovascular Disease (cardiology)
Provider IdentifiersNPI Number: 1275580755
PECOS PAC ID: 3779586870
Enrollment ID: I20060810000123
Provider NameWei Jen Sheu
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1104069392
PECOS PAC ID: 0446306625
Enrollment ID: I20090914000750
Provider NameMary Grace Leon
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1295978799
PECOS PAC ID: 8921131855
Enrollment ID: I20100729000399
Provider NameScott M Brannan
Provider TypePractitioner - Interventional Radiology
Provider IdentifiersNPI Number: 1033369707
PECOS PAC ID: 4688866619
Enrollment ID: I20120730000756
Provider NameEmma R Nunez
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1053971796
PECOS PAC ID: 5092045104
Enrollment ID: I20191002001519
Provider NameWalkennia E Simpson-earl
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1861052094
PECOS PAC ID: 8325472996
Enrollment ID: I20200107002970
Provider NamePatricia Ellen Williams
Provider TypePractitioner - Nurse Practitioner
Provider IdentifiersNPI Number: 1356990774
PECOS PAC ID: 8628406691
Enrollment ID: I20200325002835
Provider NameBabafemi Pratt
Provider TypePractitioner - Vascular Surgery
Provider IdentifiersNPI Number: 1174773873
PECOS PAC ID: 2365695509
Enrollment ID: I20201020002078
Provider NamePatrick Duffy
Provider TypePractitioner - Vascular Surgery
Provider IdentifiersNPI Number: 1477726271
PECOS PAC ID: 2264599869
Enrollment ID: I20220330000758
Provider NameMamdouh Khayat
Provider TypePractitioner - Interventional Radiology
Provider IdentifiersNPI Number: 1780941583
PECOS PAC ID: 0840428108
Enrollment ID: I20221028001223
Provider NameSamuel Putnam
Provider TypePractitioner - Interventional Radiology
Provider IdentifiersNPI Number: 1023066404
PECOS PAC ID: 5991699522
Enrollment ID: I20221129003181
Provider NamePaul Rochon
Provider TypePractitioner - Interventional Radiology
Provider IdentifiersNPI Number: 1598913980
PECOS PAC ID: 5193910875
Enrollment ID: I20221130000799
Provider NameAlexander Shestopalov
Provider TypePractitioner - Interventional Radiology
Provider IdentifiersNPI Number: 1053756098
PECOS PAC ID: 5698021756
Enrollment ID: I20221130001905

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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.