Individual provider Active NPI

Jose Eriberto Lagunda, MD

  • Pediatrics Physician
  • Bakersfield, CA
National Provider Identifier
1417016155
Registry record updated Aug 14, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
C51020 Issued in CA
Practice address
3535 San Dimas St
Suite 14
Bakersfield, CA 93301-1661
Phone
(661) 371-2810
Fax
(661) 371-2811
NPI assigned
Dec 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X C51020 CA Primary

Addresses

Primary practice location

3535 San Dimas St
Suite 14
Bakersfield, CA 93301-1661

Mailing address

11306 Crabbet Park Dr
Bakersfield, CA 93311-9226
Phone (661) 664-7641

Other identifiers 1

IdentifierTypeStateIssuer
00C510200MedicaidCA

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20171102003412 CA Practitioner - Pediatric Medicine 8628334901 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C51020CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Omni Family Health Current Accepting new patients
Omni Family Health CurrentSince Oct 16, 2017 Accepting new patients
Omni Family Health CurrentSince Oct 16, 2017 Accepting new patients
Hanford Community Hospital Past Accepting new patients
Bakersfield Memorial Hospital Past Accepting new patients
Omni Family Health Past Accepting new patients

Locations

4900 California Ave
Ste 400B
Bakersfield, CA 93309
Phone (661) 630-7046

4151 Mexicali Dr
Bakersfield, CA 93313

277 E Front St
Buttonwillow, CA 93206
Phone (661) 630-7381

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jose.lagunda.p1@direct.omnifamilyhealth.nextgenshare.com

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1165536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502668800000",
    "number": "1417016155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11306 CRABBET PARK DR",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933119226",
            "telephone_number": "661-664-7641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 SAN DIMAS ST",
            "address_2": "SUITE 14",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933011661",
            "telephone_number": "661-371-2810",
            "fax_number": "661-371-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAGUNDA",
        "first_name": "JOSE",
        "middle_name": "ERIBERTO",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-08",
        "last_updated": "2017-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C51020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C510200",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bakersfield, CA

Sources for this page

Verify at the official NPI Registry.