Lee Chaidez Mancilla, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA19534 Issued in CA

Practice address

1711 Ocean Park Blvd
Santa Monica, CA 90405-4901

Phone

(310) 450-4773

Fax

(310) 450-0873

NPI assigned

Jan 8, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JAHCCA

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.

• Westside Family Health Center

  • Community Health Clinic/Center
  • Culver City, CA
  • NPI 1831287978
  Medicare reassignment
• Westside Family Health Center

  • Clinic/Center
  • Culver City, CA
  • NPI 1407033616
  NPD (past)

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282003200000",
    "number": "1356526495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 OCEAN PARK BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904054901",
            "telephone_number": "310-450-4773",
            "fax_number": "310-450-0873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 OCEAN PARK BLVD",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904054901",
            "telephone_number": "310-450-4773",
            "fax_number": "310-450-0873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANCILLA",
        "first_name": "LEE",
        "middle_name": "CHAIDEZ",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-08",
        "last_updated": "2010-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA19534",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "19534",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pamela Kay Maloney, PHD,DHM,LAC
• Huberth Jose Maltez
• Boris Eduardovich Malyugin, MD
• Darcy A Manav, MA LMFT
• Richelle Mancewicz, M.A., LMFT
• Davinder Singh Mand, MD
• Michael Mandel, M.D.
• Bert R Mandelbaum, M.D.
• Inessa Manevich, PH.D.
• Megan Mangano, RDN

• Physician Assistant in Santa Monica, CA
• Providers in Santa Monica, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; 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.