Don Michael Endress MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A53357 Issued in CT

Legal business name

DON MICHAEL ENDRESS MD

Doing business as

Don Pedro Family Practice

Practice address

3191 El Prado Rd
Suite D
La Grange, CA 95329-9761

Phone

(209) 852-2764

Fax

(209) 852-2766

NPI assigned

May 20, 2010

Last updated

May 20, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Sandra Marie De la Torre

Title

Office Manager

Phone

(209) 874-2345

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Don Pedro Family Practice Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104145861. Details of each certification follow.

• CCN 058947 Rural health clinic · Active · Details

Rural health clinic certification: CCN 058947

Legal name

DON MICHAEL ENDRESS MD

Doing business as

DON PEDRO FAMILY PRACTICE

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Sep 7, 2010

Last certification

Aug 1, 2019

Ownership / control type

1A

Organization structure

OtherProprietary

Enrollment address

3191 El Prado Rd
Ste D
La Grange, CA 95329-9761

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Don Michael Endress, MD

  • General Practice Physician
  • Waterford, CA
  • NPI 1588664684

  5% Or Greater Direct Ownership Interest

  CMS ownership

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

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274313600000",
    "number": "1104145861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2416 CANASTA CT",
            "city": "LA GRANGE",
            "state": "CA",
            "postal_code": "953299633",
            "telephone_number": "209-852-2765",
            "fax_number": "209-852-2766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3191 EL PRADO RD",
            "address_2": "SUITE D",
            "city": "LA GRANGE",
            "state": "CA",
            "postal_code": "953299761",
            "telephone_number": "209-852-2764",
            "fax_number": "209-852-2766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DON MICHAEL ENDRESS MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-20",
        "last_updated": "2010-05-20",
        "status": "A",
        "authorized_official_last_name": "DE LA TORRE",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "209-874-2345",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CT",
            "license": "A53357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A533570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Don Pedro Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Yahaira Guadalupe Carrillo, PPS
• Josilena Marie Frye, M. ED., ED.S.
• Tyler James McDaniel, RN, FNP-S
• Kristen Nelson
• Kirsten O'Brien
• Maxxine Pena

• General Practice Physician in La Grange, CA
• Providers in La Grange, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.