Active NPI
Marie J. Galvan Renella, PA-C
- Physician Assistant
- Irvine, CA
National Provider Identifier
1053645333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA 17125
- Practice address
- 2 Osborn St Ste 180
Irvine, CA 92604-8676 - Phone
- (949) 417-9820
- Fax
- (949) 417-9830
- NPI assigned
- Sep 19, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA 17125 | CA | Primary |
Addresses
Primary practice location
2 Osborn St Ste 180
Irvine, CA 92604-8676
Mailing address
PO Box 1995
Suisun City, CA 94585-4995
Phone (657) 241-3600
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
2 Osborn St
Suite 180
Irvine, CA 92604-8676
Phone (949) 417-9820
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA 17125 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hoag Memorial Hospital Presbyterian | Past | Accepting new patients | |
| Cep America - California | Past | Accepting new patients |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Interoperability endpoints
- marie.renellapac.p17@direct.nautilus.nextgenshare.com
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.
-
- Multi-Specialty Clinic/Center
- Irvine, CA
- NPI 1942370432
-
- General Acute Care Hospital
- Newport Beach, CA
- NPI 1518951300
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Newport Beach, CA
- NPI 1518951300
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1698710400000",
"number": "1053645333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1995",
"city": "SUISUN CITY",
"state": "CA",
"postal_code": "945854995",
"telephone_number": "657-241-3600",
"fax_number": "657-241-7708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 OSBORN ST STE 180",
"city": "IRVINE",
"state": "CA",
"postal_code": "926048676",
"telephone_number": "949-417-9820",
"fax_number": "949-417-9830"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENELLA",
"first_name": "MARIE J.",
"middle_name": "GALVAN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-09-19",
"last_updated": "2023-10-31",
"certification_date": "2023-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA 17125",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.