DAVID NIKNIA, Physician Assistant

NPI 1285816868, individual, Los Angeles, CA, Physician Assistant

Evidence tier

documented action, then payment

Listed on the CA Medicaid exclusion list since June 17, 2024.
Medicaid still paid claims in 4 later months, $35,217 in total.

score 95 of 100, rank 212, $35K at stake

Public list actions

Medicare revocation effective June 19, 2025, barred from re-enrolling until September 9, 2035

424.535(a)(9) failure to report and 424.535(a)(2) provider or supplier conduct (exclusion), Practitioner - Physician Assistant, CA

OIG exclusion June 19, 2025 under section 1128b4

Ind- Lic HC Serv Pro, Physician Assistant, Beverly Hills, CA

Paid after the action

Months in which Medicaid paid claims for this provider after a public action that should have triggered a screening check. This is a record of payments, not a determination that they were improper.

list	identity check	action date	window closed	months paid after	first	last	paid after	12 months before
CA Medicaid exclusion list ca medi-cal suspended & ineligible provider list (july 2026)	Exact NPI, name verified	Jun 17, 2024	still open	4	Jul 2024	Oct 2024	$35K	$28K

National provider registry

From the CMS NPPES Registry, refreshed daily.

Name	DAVID NIKNIA, Physician Assistant
Type	Individual
Status	Active
NPI issued	December 5, 2007, last updated January 25, 2008
Practice location	12212 W WASHINGTON BLVD, Los Angeles, CA 90066-5508, 310-391-5241
Mailing address	1314 LAUREL WAY, Beverly Hills, CA 90210-2243
Specialties	Physician Assistant (363A00000X, primary, license PA14826 CA)

Procedures billed

The specific codes behind the dollars. Medicaid figures come from T-MSIS (2018 to 2024) and are compared with every other provider billing the same code; Medicare figures come from the 2024 physician and supplier file and compare this provider's submitted charge with what Medicare allowed, against the usual ratio for that code.

Medicaid, largest codes

code	what it is	paid	share	per patient-month	typical	rank among providers
99204	New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	$32K	22%	$53	$95 (top 5% from $171)	10th percentile
99214	Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	$26K	18%	$51	$60 (top 5% from $133)	37th percentile
93970	Ultrasound study of arm or leg veins with compression and maneuvers	$16K	11%	$36	$36 (top 5% from $193)	49th percentile
93306	Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	$12K	8%	$44	$52 (top 5% from $244)	40th percentile
S9083	Medicaid service code	$11K	8%	$72	$113 (top 5% from $163)	20th percentile
95924	Testing of autonomic (sympathetic and parasympathetic) nervous system function, at least 5 minutes of tilt	$8K	6%	$27	$69 (top 5% from $140)	15th percentile
99213	Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more	$7K	5%	$15	$44 (top 5% from $110)	13th percentile
J0585	Injection, onabotulinumtoxina, 1 unit	$7K	5%	$217	$836 (top 5% from $1K)	too few months to rank

Medicare Part B 2024, largest codes

code	what it is	services	beneficiaries	paid	submitted per service	allowed per service	charge to allowed	usual for this code
76770	Complete ultrasound scan behind abdominal cavity	476	463	$33K	$130	$97	1.3x	4.0x (90th percentile 8.3x)
95924	Testing of autonomic (sympathetic and parasympathetic) nervous system function, at least 5 minutes of tilt	224	210	$22K	$172	$132	1.3x	2.1x (90th percentile 4.4x)
99203	New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	244	244	$12K	$129	$98	1.3x	2.4x (90th percentile 3.9x)
99202	New patient office or other outpatient visit with straightforward medical decision making, if using time, 15 minutes or more	238	238	$8K	$90	$64	1.4x	2.3x (90th percentile 4.0x)
93970	Ultrasound study of arm or leg veins with compression and maneuvers	54	54	$7K	$236	$169	1.4x	3.8x (90th percentile 9.5x)
93306	Ultrasound of heart with color-depicted blood flow, rate, direction and valve function	94	93	$6K	$241	$173	1.4x	3.4x (90th percentile 7.7x)
93880	Ultrasound of both sides of head and neck blood flow	45	44	$6K	$240	$172	1.4x	3.3x (90th percentile 8.0x)
95923	Testing of autonomic (sympathetic) nervous system function	70	70	$6K	$143	$107	1.3x	2.5x (90th percentile 4.6x)

A submitted charge many times the allowed amount is common and lawful; it matters when it is far above what other providers submit for the same code.

In this area

399 providers in Los Angeles County, CA carry an indicator in the public record, with $129.6M at stake between them. The most common is part of a provider network, on 347 of them, followed by paid after a public list action on 36. 52 are tier 1: documented action, then payment.

tier	provider	at stake	why
1	BURBANK PREFERRED PROVIDER MEDICAL GROUP, INC Burbank, CA, ranked 17	$67K	Listed on the Medicare revocation list since October 21, 2020. Medicaid still paid claims in 24 later months, $67,101 in total. and 1 more
1	GOLDEN STAR LABS LLC Los Angeles, CA, ranked 32	$41.0M	Adjudicated (pleaded guilty) per a Department of Justice release dated June 24, 2026. Medicaid paid $41,015,276 in the last 12 observed months.
1	MATIAS CLINICAL LABORATORY INC Baldwin Park, CA, ranked 43	$3.8M	Listed on the Medicare revocation list since August 31, 2018. Medicaid still paid claims in 44 later months, $3,846,471 in total. and 1 more
1	HEALTHSMART PACIFIC INC Long Beach, CA, ranked 52	$1.6M	Listed on the OIG exclusion list since April 20, 2021. Medicaid still paid claims in 34 later months, $1,639,221 in total.
1	LINDA WARREN-WATSON Lancaster, CA, ranked 71	$828K	Listed on the CA Medicaid exclusion list since October 31, 2020. Medicaid still paid claims in 16 later months, $828,250 in total.
1	SOHRAB MOSHIRI Woodland Hills, CA, ranked 82	$483K	Listed on the WA Medicaid exclusion list since January 9, 2009. Medicaid still paid claims in 83 later months, $482,999 in total.
1	QUALITY FAMILY HOSPICE CARE INC Tarzana, CA, ranked 92	$375K	Listed on the CA Medicaid exclusion list and the Medicare revocation list since July 18, 2024. Medicaid still paid claims in 4 later months, $375,479 in total.
1	MARATHON HOSPICE CARE INC. North Hollywood, CA, ranked 95	$368K	Listed on the Medicare revocation list since July 6, 2024. Medicaid still paid claims in 4 later months, $367,866 in total.

All 399 in CA

Recent enforcement in CA

All releases

Department of Justice and HHS-OIG releases for this state, newest first. Each opens in a new tab.

DOJPleaded guiltyAug 27, 2026

Anaheim Woman Pleads Guilty to Submitting More Than $2.2 Million in Fraudulent Hospice Care Claims to Medicare

Galbraith submitted approximately $2,266,694 in claims to Medicare for hospice services for beneficiaries who did not have a terminal illness with a life expectancy of six months or less, and Medicare paid her company approximately $2,140,606.

DOJCivil settlementAug 26, 2026

DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests

DermTech Inc. submitted claims to Medicare for skin cancer tests conducted with an unvalidated positive control range and for tests lacking sufficient patient RNA, and did not retract results or adequately refund Medicare.

DOJCivil settlementAug 26, 2026

DermTech Inc. to Pay Up to $5M to Resolve Allegations It Submitted False Claims to Medicare for Unreliable Skin Cancer Tests

DermTech Inc. billed Medicare for skin cancer tests conducted using an unvalidated positive control range and for tests with insufficient patient RNA, and did not retract the results or adequately refund Medicare.

DOJCivil settlementAug 24, 2026

Medicare Advantage Provider Monogram Health Agrees to Pay $2.4 Million to Settle False Claims Act Lawsuit

Monogram knowingly submitted diagnosis codes in four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to Medicare Advantage Organizations.

DOJCivil settlementAug 24, 2026

Medicare Advantage Provider Monogram Health Agrees to Pay $2.4M to Settle False Claims Act Suit

Monogram Health knowingly submitted diagnosis codes within four HCCs that were not clinically accurate, not supported by medical record documentation, and/or did not require or affect patient care, inflating Medicare Advantage beneficiaries' risk scores and causing CMS to make higher capitated payments to MAOs.

Referral packet

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