Centrelake Medical Group Inc

A Medicare group practice based in West Covina, CA: 11 NPIs enrolled under one PECOS associate control ID (PAC ID 1658471123), with 2 clinicians.

Medicare enrollment

Medicare enrollment files
PAC ID
1658471123The PECOS associate control ID: one enrolled organization, which may hold several NPIs
Provider type
Part B Supplier - Clinic/Group Practice, Part B Supplier - Independent Diagnostic Testing Facility (Idtf)
Enrolled in
CA
Enrollments
12
Group size
2 cliniciansAs Care Compare reports it
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Practice locations
14In 11 places

Enrollment records 12

Enrollment IDStateProvider typeNPI
O20070712000571 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1639137938
O20120815000142 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1689800377
O20120815000610 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1295051365
O20151231001557 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1104293216
O20140123001266 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1760721112
O20140307000376 CA Part B Supplier - Clinic/Group Practice 1760721112
O20210324003086 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1750980967
O20191231001555 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1972070514
O20210721002019 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1912572728
O20220810003175 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1922324086
O20230728002136 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1790494128
O20230517001362 CA Part B Supplier - Independent Diagnostic Testing Facility (Idtf) 1629636006

NPIs in this group 11

NPPES NPI Registry

These NPI records belong to the same enrolled organization. Each has its own page.

Practice locations

Locations on the Medicare enrollment

Clinicians 2

Clinicians who reassign their Medicare benefits to this group (2) or whom Care Compare lists as members (2).

Sources for this page