Marlene Quilala, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A063667 Issued in CA

Practice address

359 Lakeport Blvd
Lakeport, CA 95453-5412

Phone

(707) 533-2740

Fax

(707) 263-5400

NPI assigned

Dec 5, 2006

Last updated

Oct 6, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
• Direct secure messaging: marlene.quilala.p1@direct.lcthc.nextgenshare.com

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.

• Lake County Tribal Health Consortium Inc.

  • Federally Qualified Health Center (FQHC)
  • Lakeport, CA
  • NPI 1881697381
  Medicare reassignment NPD
• Lake County Tribal Health Southshore Clinic

  • Federally Qualified Health Center (FQHC)
  • Clearlake, CA
  • NPI 1063158038
  NPD
• Sutter Bay Hospitals

  • Medicare Defined Swing Bed Hospital Unit
  • Lakeport, CA
  • NPI 1598098642
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475712000000",
    "number": "1346308855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 BLACK ROCK RIDGE RD",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "95453",
            "telephone_number": "707-262-1634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "359 LAKEPORT BLVD",
            "city": "LAKEPORT",
            "state": "CA",
            "postal_code": "954535412",
            "telephone_number": "707-533-2740",
            "fax_number": "707-263-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "QUILALA",
        "first_name": "MARLENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-05",
        "last_updated": "2016-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A063667",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hope Portney
• Mary Ruth Prather
• Praxis Infectious Diseases
• Preferred Dermatology Physician Assistant Corporation (Hadfield Dermatology, A Physician Assistant Corporation)
• Progressive Anesthesia Consultants of California
• Gabriela Patricia Quintero Contreras
• David Eric Rauch, P.T.A.
• Vivek V Reddy, M.D.
• Redwood Community Services, Inc
• Redwood Community Services, Inc.

• Pediatrics Physician in Lakeport, CA
• Providers in Lakeport, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.