Individual provider Active NPI

Conrado Martinez, PA-C

  • Physician Assistant
  • Calexico, CA
National Provider Identifier
1295983310
Registry record updated Mar 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA19858 Issued in CA
Practice address
223 W Cole Blvd
Calexico, CA 92231-9722
Phone
(760) 357-2020
Fax
(760) 357-1056
NPI assigned
Sep 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2023

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 PA19858 CA Primary

Addresses

Primary practice location

223 W Cole Blvd
Calexico, CA 92231-9722

Mailing address

852 E Danenberg Dr
El Centro, CA 92243-8517
Phone (760) 344-9951

Other identifiers 1

IdentifierTypeStateIssuer
PA 19858OtherCAP.A. LICENSE #PA 19858

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
I20081117000611 CA Practitioner - Physician Assistant 8022178359 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19858CAMDPeriodontist
PA19858CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Neighborhood Healthcare CurrentSince Sep 1, 2022 Accepting new patients
Clinicas de Salud del Pueblo Inc. CurrentSince Feb 27, 2023 Accepting new patients
Neighborhood Healthcare CurrentSince Sep 1, 2022 Accepting new patients
Clinicas de Salud del Pueblo, Inc CurrentSince Feb 27, 2023 Accepting new patients

Locations

223 W Cole Blvd
Calexico, CA 92231
Phone (760) 357-2020

852 E Danenberg Dr
El Centro, CA 92243
Phone (760) 352-2257

425 N Date St
Escondido, CA 92025
Phone (760) 737-2035

8856 Arlington Ave
Riverside, CA 92503
Phone (951) 353-2702

41840 Enterprise Cir N
Temecula, CA 92590
Phone (951) 225-6400

Interoperability endpoints

  • Direct secure messaging: cmartinez@borregomedical.directbygreenway.com
  • Direct secure messaging: conrado.martinez.p1@direct.cdsdp.nextgenshare.com

Organizations & group practices 5

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": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678233600000",
    "number": "1295983310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "852 E DANENBERG DR",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922438517",
            "telephone_number": "760-344-9951",
            "fax_number": "760-344-5840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 W COLE BLVD",
            "city": "CALEXICO",
            "state": "CA",
            "postal_code": "922319722",
            "telephone_number": "760-357-2020",
            "fax_number": "760-357-1056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "CONRADO",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2023-03-08",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "P.A. LICENSE #PA 19858",
            "identifier": "PA 19858",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Calexico, CA

Sources for this page

Verify at the official NPI Registry.