Individual provider Active NPI

Xavier Fernando Varela, PA-C

  • Medical Physician Assistant
  • Riverside, CA
National Provider Identifier
1336447689
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA9105786 Issued in FL
Practice address
4234 Riverwalk Pkwy Ste 230
Riverside, CA 92505-3312
Phone
(951) 781-3672
Fax
(951) 781-0365
NPI assigned
Mar 10, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA9105786 FL Primary

Addresses

Primary practice location

4234 Riverwalk Pkwy Ste 230
Riverside, CA 92505-3312

Mailing address

4234 Riverwalk Pkwy Ste 230
Riverside, CA 92505-3312
Phone (951) 781-3672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, FL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150529002163 CA Practitioner - Physician Assistant 9335460534 Reassigns benefits to 7 organizations
I20200910000602 FL Practitioner - Physician Assistant 9335460534 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9105786FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health System/Sunbelt, Inc. CurrentSince Aug 10, 2020 Accepting new patients
Adventist Health System/ Sunbelt, Inc. CurrentSince Aug 10, 2020 Accepting new patients
County of Santa Clara CurrentSince Mar 8, 2015 Accepting new patients
County of Santa Clara CurrentSince Mar 8, 2015 Accepting new patients
Pacific Professional Surgical Group Inc Past Accepting new patients

Locations

751 S Bascom Ave
San Jose, CA 95128
Phone (408) 885-5110

225 N Jackson Ave
San Jose, CA 95116
Phone (408) 347-4051

440 W State Road 436
Altamonte Springs, FL 32714
Phone (407) 788-2000

2600 Westhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 200-1353

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1336447689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4234 RIVERWALK PKWY STE 230",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053312",
            "telephone_number": "951-781-3672",
            "fax_number": "951-781-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4234 RIVERWALK PKWY STE 230",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925053312",
            "telephone_number": "951-781-3672",
            "fax_number": "951-781-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARELA",
        "first_name": "XAVIER",
        "middle_name": "FERNANDO",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-10",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9105786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.