IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP (NPI# 1750348033) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750348033 |
| Entity Type | Organization |
| Organization Name | IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP |
| Other Organization Name | IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP LABORATORY |
| Practice Address |
516 West Aten Road Suite 3 Imperial CA 92251 |
| Mailing Address |
516 West Aten Road Suite 2 Imperial CA 92251 |
| Practice Telephone | 7603552701 |
| Practice Fax Number | 7603558397 |
| Mailing Telephone | 7603557730 |
| Mailing Fax Number | 7603557731 |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2008-04-24 |
| Authorized Official Name | VACHASPATHI PALAKODETI (PRESIDENT) |
| Authorized Official Telephone | 7603557730 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 291U00000X | Clinical Medical Laboratory | 05D0973957 | CA | Laboratories |
| Y | 291U00000X | Clinical Medical Laboratory | 05D0681409 | CA | Laboratories |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | CLIA # | 05D0681409 | 01 |
| CA | RAIL ROAD PIN | P00164275 | 01 |
| CA | RAILROAD GROUP # | CC6635 | 01 |
| CA | GROUP NPI | 1275581894 | 01 |
| CA | LAB81409F | 05 |
| Other Name | Type Code |
|---|---|
| Imperial Valley Family Care Medical Group Laboratory | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376820159 | Imperial Valley Family Care Medical Group | General Practice | 1520 South Imperial Avenue, El Centro, CA 92243 | 2011-11-08 |
| Street Address |
516 WEST ATEN ROAD SUITE 3 |
| City | IMPERIAL |
| State | CA |
| Zip Code | 92251 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922324326 | Stephanie Michelle Brammer | Physician Assistant | 516 West Aten Road, Suite 1, Imperial, CA 92251 | 2010-04-12 |
| 1649224387 | Vachaspathi Palakodeti | Internal Medicine | 516 West Aten Road, Suite 1, Imperial, CA 92251 | 2006-05-19 |
| 1275581894 | Imperial Valley Family Care Medical Group Apc | General Practice | 516 West Aten Road, Suite 2, Imperial, CA 92251 | 2006-05-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134656317 | Fronteras Interpreting | Interpreter | 284 W La Paz Drive, Imperial, CA 92251 | 2017-05-18 |
| 1639613128 | Surgery Centers of Imperial Valley Inc | Clinic/Center | 2402 Business Parkway, Suite 101, Imperial, CA 92251 | 2016-12-19 |
| 1508010315 | Bethzyra Guevara | Rehabilitation Counselor | 624 Ruby Street, Imperial, CA 92251 | 2008-11-06 |
| 1396929345 | Byron Justus | Dentist | 2387 Us Highwy 86, Imperial, CA 92251 | 2007-12-27 |
| 1154503894 | Gary G Cummings | Dentist | 2302 Brown Rd., Centinela State Prison, Imperial, CA 92251 | 2007-12-05 |
| 1396925160 | Dave Sat Khatri | Internal Medicine | 2302 Brown Road, Centinela State Prison, Imperial, CA 92251 | 2007-11-09 |
| 1144420928 | Freddy Carreno | Nurse Practitioner | 2302 Brown Rd, Imperial, CA 92251 | 2007-07-20 |
| 1336289818 | Herbert Ray Bumgart Jr. | Rehabilitation Counselor | 1295 State St Suite 106, El Centro, CA 92251 | 2007-02-07 |
| 1578668976 | Volunteers of America Southwest California | Skilled Nursing Facility | 100 E. Second Street, Imperial, CA 92251 | 2006-09-13 |
| 1598780736 | Bernardo Ng | Psychiatry & Neurology | 2417 Marshall Ave, Ste 1, Imperial, CA 92251 | 2006-07-12 |
| Find all providers in zip 92251 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134441082 | Douglas Edward Poss | Clinical Medical Laboratory | 5208 Lakewood Ter, 101, Imperial, MO 63052-4046 | 2010-02-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.