Coachella Valley Retina

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

COACHELLA VALLEY RETINA

Practice address

72301 Country Club Dr
108
Rancho Mirage, CA 92270-8007

Phone

(760) 895-1993

NPI assigned

Oct 7, 2013

Last updated

Nov 25, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Camille Harrison, MDNPI 1366520140

Title

Owner

Phone

(760) 895-1993

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Coachella Valley Retina2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Coachella Valley Retina

  • Ophthalmology Physician
  • Rancho Mirage, CA
  • NPI 1871928945
  NPD tax ID

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Camille M. Harrison, MD

  • Ophthalmology Physician
  • Rancho Mirage, CA
  • NPI 1366520140
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1381104000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385337600000",
    "number": "1376970228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72301 COUNTRY CLUB DR",
            "address_2": "108",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922708007",
            "telephone_number": "760-895-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72301 COUNTRY CLUB DR",
            "address_2": "108",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922708007",
            "telephone_number": "760-895-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COACHELLA VALLEY RETINA",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-07",
        "last_updated": "2013-11-25",
        "status": "A",
        "authorized_official_last_name": "HARRISON",
        "authorized_official_first_name": "CAMILLE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-895-1993",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coachella Care Clinic
• Coachella Valley Direct Primary Care
• Coachella Valley Eye Institute PC
• Coachella Valley Pathology
• Coachella Valley Pharmacy Inc (Coachella Valley LTC)
• Coachella Valley Retina
• Coachellamed a Professional Corporation (Coachellamed)
• Eliane Fani Coffler
• Randy E Cohen, M.D.
• Morton James Cohn, M.D.

• Ophthalmology Physician in Rancho Mirage, CA
• Providers in Rancho Mirage, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.