NPIMap

Organization Active NPI

De la Pena Eye Clinic, a Medical Group, Inc.

  • Ophthalmology Physician
  • Montebello, CA
National Provider Identifier
1114931052
Registry record updated Aug 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
DE LA PENA EYE CLINIC, A MEDICAL GROUP, INC.
Practice address
2446 W Whittier Blvd
Montebello, CA 90640-3041
Phone
(323) 728-5500
Fax
(323) 728-4408
NPI assigned
Jul 28, 2006
Last updated
Aug 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2022

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

Authorized official

Name
Mark Kelly
Title
Member, Board of Managers
Phone
(615) 345-6900

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

2446 W Whittier Blvd
Montebello, CA 90640-3041

Mailing address

401 Commerce St Ste 600
Nashville, TN 37219-2518
Phone (615) 345-6900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031223000882 CA Part B Supplier - Clinic/Group Practice 2961300116 Receives reassigned benefits from 36 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Huntington Park, CA; Whittier, CA; Van Nuys, CA; Santa Ana, CA; Montebello, CA; Los Angeles, CA; Long Beach, CA; El Monte, CA

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

10942 Ramona Blvd
El Monte, CA 91731

2246 W Whittier Blvd
Montebello, CA 90640

2445 W Whittier Blvd
Ste 100
Montebello, CA 90640
Phone (323) 727-2550

801 N Tustin Ave
Ste 201
Santa Ana, CA 92705
Phone (714) 245-2409

7100 Van Nuys Blvd
Ste 1
Van Nuys, CA 91405

7749 Painter Ave
Whittier, CA 90602
Phone (562) 945-6391

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660262400000",
    "number": "1114931052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 COMMERCE ST STE 600",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192518",
            "telephone_number": "615-345-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2446 W WHITTIER BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906403041",
            "telephone_number": "323-728-5500",
            "fax_number": "323-728-4408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DE LA PENA EYE CLINIC, A MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2022-08-12",
        "certification_date": "2022-08-12",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MEMBER, BOARD OF MANAGERS",
        "authorized_official_telephone_number": "615-345-6900"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montebello, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.