NPIMap

Individual provider Active NPI

Edgard Mario Vera Tapia, MD

  • Nephrology Physician
  • Victorville, CA
National Provider Identifier
1235127515
Registry record updated Nov 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A79177 Issued in CA
Practice address
17207 Jasmine St
2
Victorville, CA 92395
Phone
(760) 780-4179
Fax
(760) 241-4591
NPI assigned
Oct 11, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A79177 CA Primary

Addresses

Primary practice location

17207 Jasmine St
2
Victorville, CA 92395

Mailing address

17207 Jasmine St
2
Victorville, CA 92395
Phone (760) 780-4179

Other identifiers 4

IdentifierTypeStateIssuer
10050B175MedicaidNV
00A791770MedicaidCA
1871734921MedicaidCA
1235127515MedicaidCA

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
I20091023000448 CA Practitioner - NephrologyPractitioner - Internal Medicine 2961483946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edgard M Vera MD IncGroup PAC ID 3971640988, 4 clinicians

Practice addresses (Care Compare)

17207 Jasmine St
Suite 2
Victorville, CA 92395-8322
Phone (760) 780-4179

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
79177CAMDMental Health Counselor
A79177CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
High Desert Nephrology Medical Associates, Inc. Nephrology Current Accepting new patients
Edgard M Vera MD Inc Nephrology CurrentSince May 1, 2009 Accepting new patients
St. Mary Medical Center Past Accepting new patients
Spring Valley Medical Center Past Accepting new patients
Victor Valley Community Hospital Past Accepting new patients
Hospital of Barstow Inc Past Accepting new patients
Desert Valley Hospital, LLC Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

16049 Kamana Rd
Apple Valley, CA 92307
Phone (760) 242-8311

15990 Tuscola Rd
Apple Valley, CA 92307
Phone (760) 242-4808

16850 Bear Valley Rd
Victorville, CA 92395
Phone (760) 241-8222

17207 Jasmine St
Ste 2
Victorville, CA 92395
Phone (760) 780-4179

17207 Jasmine St
Victorville, CA 92395
Phone (760) 241-8167

12675 Hesperia Rd
Victorville, CA 92395
Phone (760) 241-3306

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: edgard.vera@direct.davitaphysiciansolutions.com

Organizations & group practices 8

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 9

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": "1128988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1235127515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17207 JASMINE ST",
            "address_2": "2",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "92395",
            "telephone_number": "760-780-4179",
            "fax_number": "760-241-4591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17207 JASMINE ST",
            "address_2": "2",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "92395",
            "telephone_number": "760-780-4179",
            "fax_number": "760-241-4591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERA TAPIA",
        "first_name": "EDGARD",
        "middle_name": "MARIO",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-10-11",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A79177",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10050B175",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A791770",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1871734921",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235127515",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victorville, CA

Sources for this page

Verify at the official NPI Registry.