PRIMCARE MEDICAL CENTER INC
NPI 1033082318
Family Medicine - Geriatric Medicine in North Hollywood, CA

Active since September 24, 2025CLIA 05D2339623 · Waiver
11755 VICTORY BLVD STE 100B, NORTH HOLLYWOOD, CA 91606(747) 203-1909(747) 205-2063 Get Directions Write a Review

NPPES record last updated: January 15, 2026. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Primcare Medical Center Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRIMCARE MEDICAL CENTER INC (NPI 1033082318) is a healthcare organization registered as a geriatric medicine in North Hollywood, California and active in the NPI registry since September 2025. The organization holds a CLIA Waiver certificate valid through March 3, 2028 and lists Nicholas Dzebolo, Ceo/ Owner, as its authorized official.

NPPES Registry Identity

NPI1033082318
Entity TypeOrganization
Primary Taxonomy207QG0300X
Legal Business NamePRIMCARE MEDICAL CENTER INC
Location Address11755 VICTORY BLVD STE 100BNorth Hollywood, CA 91606-3423
Mailing Address11755 Victory Blvd Ste 100bNorth Hollywood, CA 91606-3423 · (747) 203-1909 · Fax (747) 205-2063
Fax(747) 205-2063
Organization SubpartNo
Authorized OfficialNicholas DzeboloCeo/ Owner · (747) 265-6308
Enumeration DateSeptember 24, 2025
Last NPPES UpdateJanuary 15, 2026
NPPES CertifiedJanuary 15, 2026
✔ NPI 1033082318 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QG0300X
Definition
A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.
11755 VICTORY BLVD STE 100B, North Hollywood, CA 91606

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Primcare Medical Center Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Primcare Medical Center Inc, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Nurse Practitioner
NPI 1093415424
401 N BRAND BLVD # 726
Glendale, CA 91203
(818) 239-9293
✔ PECOS✔ Accepts Medicare8.1 mi
Nurse Practitioner
NPI 1689543274
28621 WINDBREAK TER
Santa Clarita, CA 91350
(213) 514-4407
✔ PECOS✔ Accepts Medicare18 mi
General Radiology
NPI 1932239837
1765 CHALLENGE WAY STE 130
Sacramento, CA 95815
(916) 905-5363
✔ PECOS✔ Accepts Medicare348 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2339623

Primcare Medical Center Inc · Tarzana, CA
Active · expires Mar 3, 2028
CLIA Number05D2339623
Laboratory TypePhysician Office
Certificate Effective DateMarch 4, 2026
Certificate Expiration DateMarch 3, 2028
Laboratory DirectorNicholas Dzebolo
Laboratory Phone(747) 265-6308
Laboratory LocationPrimcare Medical Center Inc18345 Ventura Blvd, Ste 202, Tarzana, CA 91356
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Primcare Medical Center Inc's NPI number?

The NPI number for Primcare Medical Center Inc is 1033082318. It was assigned to this organization in the NPPES registry on September 24, 2025.

Where is Primcare Medical Center Inc located?

Primcare Medical Center Inc is located at 11755 Victory Blvd Ste 100B, North Hollywood, CA 91606. The listed phone number is (747) 203-1909.

What is Primcare Medical Center Inc's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Geriatric Medicine, with taxonomy code 207QG0300X.

Is Primcare Medical Center Inc enrolled in Medicare?

Yes. Primcare Medical Center Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Primcare Medical Center Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Primcare Medical Center Inc, in General Radiology and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Primcare Medical Center Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2339623) is associated with this NPI, valid through March 3, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Primcare Medical Center Inc was last updated on January 15, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.