Individual provider Active NPI

Daniel Rivas-Tejada, PA

  • Physician Assistant
  • Pico Rivera, CA
National Provider Identifier
1043456973
Registry record updated Sep 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19638 Issued in CA
Practice address
6758 Passons Blvd
Pico Rivera, CA 90660-3666
Phone
(562) 654-6899
Fax
(562) 654-6895
NPI assigned
Dec 23, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA19638 CA Primary

Addresses

Primary practice location

6758 Passons Blvd
Pico Rivera, CA 90660-3666

Mailing address

6758 Passons Blvd
Pico Rivera, CA 90660-3666
Phone (562) 654-6899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090306000226 CA Practitioner - Physician Assistant 2163588781 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kevin J Pelton MD IncGroup PAC ID 3375625486, 38 clinicians

Practice addresses (Care Compare)

12215 Telegraph Rd
Suite 112
Santa Fe Springs, CA 90670-3344
Phone (562) 548-2230

1700 E Cesar Chavez Ave
Suite 2200
Los Angeles, CA 90033-2476

1700 E Cesar E Chavez Ave
Suite 2200
Los Angeles, CA 90033-2476
Phone (323) 264-7600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA19638CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kevin J. Pelton MD, Inc. CurrentSince Nov 24, 2020 Accepting new patients
Kevin J Pelton MD Inc CurrentSince Nov 24, 2020 Accepting new patients
Kevin J. Pelton MD, Inc. Past Accepting new patients

Locations

1700 E Cesar E Chavez Ave
Ste 2200
Los Angeles, CA 90033
Phone (323) 264-7600

6758 Passons Blvd
Pico Rivera, CA 90660
Phone (562) 654-6894

12215 Telegraph Rd
Ste 112
Santa Fe Springs, CA 90670
Phone (562) 548-2230

18840 Ventura Blvd
#208
Tarzana, CA 91356

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1043456973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6758 PASSONS BLVD",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906603666",
            "telephone_number": "562-654-6899",
            "fax_number": "562-654-6895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6758 PASSONS BLVD",
            "city": "PICO RIVERA",
            "state": "CA",
            "postal_code": "906603666",
            "telephone_number": "562-654-6899",
            "fax_number": "562-654-6895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVAS-TEJADA",
        "first_name": "DANIEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-12-23",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19638",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pico Rivera, CA

Sources for this page

Verify at the official NPI Registry.