Carlos Miguel Leal, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

51253 Issued in CA

Practice address

1100 Paseo Camarillo
Camarillo, CA 93010-6073

Phone

(805) 484-8558

Fax

(805) 484-3099

NPI assigned

Oct 28, 2013

Last updated

Aug 11, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment Care Compare group
• County of Ventura

  dba Ventura County Medical Center

  • General Acute Care Hospital
  • Ventura, CA
  • NPI 1629167457
  Medicare reassignment
• County of Ventura

  dba VCBH - Conejo Valley Adult Mental Health

  • Community/Behavioral Health Agency
  • Thousand Oaks, CA
  • NPI 1467571422
  NPD
• County of Ventura

  dba VCBH - Simi Valley Youth & Family Mental Health

  • Community/Behavioral Health Agency
  • Simi Valley, CA
  • NPI 1609098243
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Woodland Hills, CA
  • NPI 1952333478
  NPD

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

{
    "created_epoch": "1382918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1043648132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 PASEO CAMARILLO",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "93010",
            "telephone_number": "805-484-8558",
            "fax_number": "805-484-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 PASEO CAMARILLO",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930106073",
            "telephone_number": "805-484-8558",
            "fax_number": "805-484-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEAL",
        "first_name": "CARLOS",
        "middle_name": "MIGUEL",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-10-28",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "51253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Liliana Yazmin Lazcano Frausto
• Diana Le
• Hailey Le
• Leading Edge Innovations
• Leading Edge Transitions
• Arious K. Lee
• Dexter Lee, DDS
• Karis Lee
• Kathleen C Lee, M.A., SLP
• Saraa Doris Lee

• Medical Physician Assistant in Camarillo, CA
• Providers in Camarillo, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.