NPIMap

Individual provider Active NPI

Pablo Gonzalo Echevarria Villanueva-Meyer

  • Nephrology Physician
  • Glendale, CA
National Provider Identifier
1083076814
Registry record updated Jul 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A173166 Issued in CA
Practice address
1505 Wilson Ter Ste 155
Glendale, CA 91206-4032
Phone
(818) 500-4055
NPI assigned
Mar 22, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A173166 CA
Student in an Organized Health Care Education/Training Program 390200000X
Nephrology Physician 207RN0300X A173166 CA Primary

Addresses

Primary practice location

1505 Wilson Ter Ste 155
Glendale, CA 91206-4032

Mailing address

1505 Wilson Ter Ste 155
Glendale, CA 91206-4032

Other practice location 1

3150 N Tenaya Way
Suite 480
Las Vegas, NV 89128-0443
Phone (702) 562-5831

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220714004191 CA Practitioner - Internal Medicine 5597050054 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Texas Medical Branch at Galveston, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kidney Disease Medical Group IncGroup PAC ID 3173542198, 8 clinicians

Practice addresses (Care Compare)

1505 Wilson Ter
Suite 155
Glendale, CA 91206-4032
Phone (818) 500-4055

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A173166CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kidney Disease Medical Group Inc CurrentSince Jun 1, 2022 Accepting new patients

Locations

1505 Wilson Ter
Ste 155
Glendale, CA 91206
Phone (818) 500-4055

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: pablo.villanuevameyer@hca3.eclinicaldirectplus.com
  • Direct secure messaging: pablo.gonzalo.villanueva-meyer.1@15679.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/15679/brand/1/csg/1/fhir/r4

Organizations & group practices 1

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1458604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625616000000",
    "number": "1083076814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 WILSON TER STE 155",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 WILSON TER STE 155",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064032",
            "telephone_number": "818-500-4055"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3150 N Tenaya Way",
            "address_2": "Suite 480",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891280443",
            "country_code": "US",
            "telephone_number": "702-562-5831",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VILLANUEVA-MEYER",
        "first_name": "PABLO GONZALO",
        "middle_name": "ECHEVARRIA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-22",
        "last_updated": "2021-07-07",
        "certification_date": "2021-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A173166",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A173166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.