GHOLAMREZA REZVANI DDS
NPI 1437813029
Dentist - General Practice in Willows, CA
About Gholamreza Rezvani Dds NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GHOLAMREZA REZVANI DDS (NPI 1437813029) is an individual general practice provider in Willows, California, licensed in California (0401417703) and active in the NPI registry since October 2021. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Gholamreza Rezvani Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Gholamreza Rezvani reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Clearlake, CA 95422
- Reassigned Medicare billing, California enrollment
- Medicare enrollment name: Lake County Tribal Health Consortium Inc
- 59 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 95988 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
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 Gholamreza Rezvani's NPI number?
The NPI number for Gholamreza Rezvani is 1437813029. It was assigned to this individual provider in the NPPES registry on October 29, 2021.
Where is Gholamreza Rezvani located?
Gholamreza Rezvani practices at 207 N Butte St, Willows, CA 95988. The listed phone number is (530) 934-4641.
What is Gholamreza Rezvani's specialty?
The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.
Is Gholamreza Rezvani enrolled in Medicare?
Yes. Gholamreza Rezvani is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Gholamreza Rezvani's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Gholamreza Rezvani reassigns Medicare benefits to Lake County Tribal Health Southshore Clinic (Clearlake, CA). The 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 Gholamreza Rezvani's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Gholamreza Rezvani accept?
Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas list Gholamreza Rezvani as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Gholamreza Rezvani was last updated on October 29, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.
# Gholamreza Rezvani, DDS · NPI 1437813029
General Practice provider in Willows, California. Individual provider, active in the CMS NPPES registry since October 29, 2021.
## Identity
- **NPI:** 1437813029 (Entity type: Individual)
- **Enumerated:** October 29, 2021
- **Primary specialty:** Dentist - General Practice · taxonomy 1223G0001X
- **State license:** 0401417703 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 207 N BUTTE ST, Willows, CA 95988-2803
- **Phone:** (530) 934-4641
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health
- **Bills Medicare through:** Lake County Tribal Health Southshore Clinic (NPI 1063158038, Clearlake, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 29, 2021
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Source: [NPI Profile](https://npiprofile.com/npi/1437813029) · Data from the CMS NPPES public registry.