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BRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP
NPI 1720322415
Internal Medicine in Los Angeles, CA

Active since November 19, 2012
11645 WILSHIRE BLVD, SUITE 745, LOS ANGELES, CA 90025(310) 696-0101 Get Directions Write a Review

NPPES record last updated: February 26, 2018. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Brentwood Medical Group A Professional Medical Corp NPPES

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

BRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP (NPI 1720322415) is a healthcare organization registered as an internal medicine in Los Angeles, California and active in the NPI registry since November 2012. The organization lists Javid Tavari, President, as its authorized official.

NPPES Registry Identity

NPI1720322415
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameBRENTWOOD MEDICAL GROUP A PROFESSIONAL MEDICAL CORP
Location Address11645 WILSHIRE BLVD, SUITE 745Los Angeles, CA 90025-1708
Mailing Address11645 Wilshire Blvd, Suite 745Los Angeles, CA 90025-1708 · (310) 696-0101
Phone(310) 696-0101
Organization SubpartNo
Authorized OfficialJavid TavariPresident · (310) 696-0101
Enumeration DateNovember 19, 2012
Last NPPES UpdateFebruary 26, 2018
✔ NPI 1720322415 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in CA · 20A6273
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
11645 WILSHIRE BLVD, Los Angeles, CA 90025
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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)

Brentwood Medical Group A Professional Medical Corp is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Brentwood Medical Group A Professional Medical Corp, which bills Medicare for the services this clinician delivers.

Clinician (1)

Javid Tavari, D.O.
Internal Medicine
NPI 1669400602
11645 WILSHIRE BLVD SUITE 745
Los Angeles, CA 90025
(310) 696-0100
✔ PECOS✔ Accepts MedicareSame address

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

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 Brentwood Medical Group A Professional Medical Corp's NPI number?

The NPI number for Brentwood Medical Group A Professional Medical Corp is 1720322415. It was assigned to this organization in the NPPES registry on November 19, 2012.

Where is Brentwood Medical Group A Professional Medical Corp located?

Brentwood Medical Group A Professional Medical Corp is located at 11645 Wilshire Blvd Suite 745, Los Angeles, CA 90025. The listed phone number is (310) 696-0101.

What is Brentwood Medical Group A Professional Medical Corp's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Brentwood Medical Group A Professional Medical Corp enrolled in Medicare?

Yes. Brentwood Medical Group A Professional Medical Corp is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Brentwood Medical Group A Professional Medical Corp?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Internal Medicine) reassigns their Medicare billing to Brentwood Medical Group A Professional Medical Corp. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Brentwood Medical Group A Professional Medical Corp was last updated on February 26, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.