Individual provider Active NPI

Michael A Davalos, PA, MS

  • Physician Assistant
  • Wildomar, CA
National Provider Identifier
1285641902
Registry record updated Oct 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA17328 Issued in CA
Practice address
36243 Inland Valley Dr
Ste 180
Wildomar, CA 92595
Phone
(951) 600-0110
Fax
(951) 600-4645
NPI assigned
Aug 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2007

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 PA17328 CA Primary

Addresses

Primary practice location

36243 Inland Valley Dr
Ste 180
Wildomar, CA 92595

Mailing address

36243 Inland Valley Dr
Ste 180
Wildomar, CA 92595
Phone (951) 600-0110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060906000475 CA Practitioner - Physician Assistant 5799789731 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Medical DoctorsGroup PAC ID 2961305651, 168 clinicians
Carbon Health Medical Group of California PCGroup PAC ID 9032340047, 335 clinicians

Practice addresses (Care Compare)

2083 Compton Ave
Suite 104
Corona, CA 92881-7288
Phone (951) 837-3151

31845 Temecula Pkwy
Suite 102
Temecula, CA 92592-2871
Phone (951) 210-7368

3955 Bedford Canyon Rd
Unit 103
Corona, CA 92883-3627
Phone (951) 293-4722

Hospital & facility affiliations

  • Riverside University Health System-Medical Center Hospital, Moreno Valley, CA, CCN 050292

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
United Medical Doctors CurrentSince Nov 7, 2023 Accepting new patients
Cep America - California CurrentSince Nov 1, 2007 Accepting new patients
Premier Emergency Physicians of California Medical Group PC Physician Assistant Past Accepting new patients
Rainbow Basin Emergency Physicians, a Medical Corporation Physician Assistant Past Accepting new patients

Locations

2083 Compton Ave
Ste 104
Corona, CA 92881
Phone (951) 256-8191

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

521 E Elder St
Ste 104
Fallbrook, CA 92028
Phone (760) 728-9560

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

400 Newport Center Dr
Ste 609
Newport Beach, CA 92660
Phone (949) 760-0398

1150 N Indian Canyon Dr
Palm Springs, CA 92262
Phone (760) 323-6251

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/9170/brand/1/csg/1/fhir/r4

Organizations & group practices 7

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 1

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": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193616000000",
    "number": "1285641902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36243 INLAND VALLEY DR",
            "address_2": "STE 180",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "92595",
            "telephone_number": "951-600-0110",
            "fax_number": "951-600-4645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36243 INLAND VALLEY DR",
            "address_2": "STE 180",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "92595",
            "telephone_number": "951-600-0110",
            "fax_number": "951-600-4645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVALOS",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "credential": "PA, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2007-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildomar, CA

Sources for this page

Verify at the official NPI Registry.