NPIMap

Individual provider Active NPI

Daniel Villalobos Jr., PA-C

  • Physician Assistant
  • Wellington, NV
National Provider Identifier
1265959423
Registry record updated Oct 4, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA1893 Issued in NV
Practice address
445 State Route 338
Wellington, NV 89444-9711
Phone
(775) 465-2587
NPI assigned
Aug 28, 2017
Last updated
Oct 4, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA1893 NV Primary

Addresses

Primary practice location

445 State Route 338
Wellington, NV 89444-9711

Mailing address

445 State Route 338
Wellington, NV 89444-9711
Phone (775) 463-2301

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20171122001600 NV Practitioner - Physician Assistant 8224395595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Lyon Health Center IncGroup PAC ID 0648178533, 20 clinicians

Practice addresses (Care Compare)

213 S Whitacre St
Yerington, NV 89447-2561
Phone (775) 463-2301

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA1893NVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Saint Marys Urgent Care LLC Current Accepting new patients
South Lyon Health Center, Inc. CurrentSince Sep 29, 2017 Accepting new patients
Saint Mary's Medical Group Inc CurrentSince Aug 10, 2020 Accepting new patients
Saint Marys Medical Group Inc. CurrentSince Aug 10, 2020 Accepting new patients
South Lyon Health Center, Inc. PastSince May 28, 2023 Accepting new patients

Locations

1801 W Olympic Blvd
#1461
Pasadena, CA 91199

18653 Wedge Pkwy
Ste 110
Reno, NV 89511
Phone (775) 352-7201

411 W 6th St
Reno, NV 89503
Phone (775) 770-3209

213 S Whitacre St
Yerington, NV 89447
Phone (775) 463-2301

Interoperability endpoints

  • Direct secure messaging: daniel.villalobos.p1@direct.smmg.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1503878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507075200000",
    "number": "1265959423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 STATE ROUTE 338",
            "city": "WELLINGTON",
            "state": "NV",
            "postal_code": "894449711",
            "telephone_number": "775-463-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 STATE ROUTE 338",
            "city": "WELLINGTON",
            "state": "NV",
            "postal_code": "894449711",
            "telephone_number": "775-465-2587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLALOBOS",
        "first_name": "DANIEL",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-28",
        "last_updated": "2017-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NV",
            "license": "PA1893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wellington, NV

Sources for this page

Verify at the official NPI Registry.