NPIMap

Individual provider Active NPI

Elias Ignacio Banuelos, MD

  • Family Medicine Physician
  • Calistoga, CA
National Provider Identifier
1366427064
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A72691 Issued in CA
Practice address
911 Washington St
Calistoga, CA 94515-1433
Phone
(707) 709-2308
NPI assigned
Dec 14, 2005
Last updated
Sep 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME97139 FL
Family Medicine Physician 207Q00000X A72691 CA Primary

Addresses

Primary practice location

911 Washington St
Calistoga, CA 94515-1433

Mailing address

1141 Pear Tree LN Ste 100
Napa, CA 94558-6485
Phone (707) 254-1770

Other identifiers 1

IdentifierTypeStateIssuer
00A726910MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220906001518 CA Practitioner - Family Practice 1052414992 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Stanford University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1524 W Lacey Blvd
Suite 101
Hanford, CA 93230-5990
Phone (559) 583-4695

821 S Saint Helena Hwy
Suite 2
Saint Helena, CA 94574-2266
Phone (707) 968-9232

913 Washington St
Calistoga, CA 94515-1433

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A72691CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network Current Accepting new patients
Adventist Health Physicians Network CurrentSince Jan 1, 2025 Accepting new patients
Ole Health CurrentSince Sep 1, 2022 Accepting new patients
Adventist Health Physicians Network CurrentSince Jan 1, 2025 Accepting new patients
Ole Health CurrentSince Sep 1, 2022 Accepting new patients
Ole Health Current Accepting new patients
Tri Hospital MRI Center Past Accepting new patients
Santa Rosa Hma Urgent Care LLC Past Accepting new patients
Adventist Health Heart Institute-Ukiah Past Accepting new patients
Vipcare Dental PLLC PastSince Feb 1, 2019 Accepting new patients
Sacred Heart Health System, Inc. Past Accepting new patients

Locations

911 Washington St
Calistoga, CA 94515
Phone (707) 709-2308

913 Washington St
Calistoga, CA 94515
Phone (707) 942-0844

1141 Pear Tree Ln
Ste 100
Napa, CA 94558
Phone (707) 254-1778

10 Woodland Rd
Saint Helena, CA 94574
Phone (707) 963-2002

1222 Pine St
Ste A
Saint Helena, CA 94574
Phone (707) 963-0931

821 Saint Helena Hwy S
Saint Helena, CA 94574
Phone (707) 963-5006

Organizations & group practices 11

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1366427064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1141 PEAR TREE LN STE 100",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945586485",
            "telephone_number": "707-254-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 WASHINGTON ST",
            "city": "CALISTOGA",
            "state": "CA",
            "postal_code": "945151433",
            "telephone_number": "707-709-2308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANUELOS",
        "first_name": "ELIAS",
        "middle_name": "IGNACIO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-14",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME97139",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A72691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A726910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Calistoga, CA

Sources for this page

Verify at the official NPI Registry.