Individual provider Active NPI

Robert Decaro, PA-C

  • Physician Assistant
  • Hemet, CA
National Provider Identifier
1285814632
Registry record updated Jul 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
CALIFORNIA Issued in CA
Practice address
1264 E Latham Ave
Hemet, CA 92543-4445
Phone
(951) 925-3600
NPI assigned
Nov 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2019

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 CALIFORNIA CA Primary

Addresses

Primary practice location

1264 E Latham Ave
Hemet, CA 92543-4445

Mailing address

9 Ponte Chara
Lake Elsinore, CA 92532-0231
Phone (951) 245-6357

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
I20080528000400 CA Practitioner - Physician Assistant 7517037948 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19527CAMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hemet Healthcare Surgicenter, Inc. Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1285814632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 PONTE CHARA",
            "city": "LAKE ELSINORE",
            "state": "CA",
            "postal_code": "925320231",
            "telephone_number": "951-245-6357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1264 E LATHAM AVE",
            "city": "HEMET",
            "state": "CA",
            "postal_code": "925434445",
            "telephone_number": "951-925-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECARO",
        "first_name": "ROBERT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-13",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "CALIFORNIA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hemet, CA

Sources for this page

Verify at the official NPI Registry.