NPIMap

Individual provider Active NPI

Luzviminda T. Montecillo, MD

  • Internal Medicine Physician
  • Inglewood, CA
National Provider Identifier
1447348149
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A52290 Issued in CA
Practice address
645 Aerick St
Suite 1
Inglewood, CA 90301-4881
Phone
(310) 673-2764
Fax
(310) 673-2403
NPI assigned
Oct 10, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A52290 CA Primary

Addresses

Primary practice location

645 Aerick St
Suite 1
Inglewood, CA 90301-4881

Mailing address

719 High LN
Redondo Beach, CA 90278-5107
Phone (310) 673-2764

Other identifiers 1

IdentifierTypeStateIssuer
00A522900MedicaidCA

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
I20041102000453 CA Practitioner - Internal Medicine 9335112416 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1974
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

645 Aerick St
Suite 1
Inglewood, CA 90301-4882
Phone (310) 673-2764

719 High LN
Redondo Beach, CA 90278-5107

Hospital & facility affiliations

  • Holy Angel Home Health Care, Inc Home health agency, Los Angeles, CA, CCN 058259
  • K & K Home Health Care, Inc Home health agency, Glendale, CA, CCN 053120
  • Angel Touch Home Health Care, Corp. Home health agency, Los Angeles, CA, CCN 758208
  • VRT Home Health Care Home health agency, Glendale, CA, CCN 559456
  • Homereach Hospice Hospice, Signal Hill, CA, CCN 051731
  • Century Villa, Inc Nursing home, Inglewood, CA, CCN 555368
  • Inglewood Health Care Center Nursing home, Inglewood, CA, CCN 055526

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as individual
Quality
80.63
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A52290CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Luzviminda T Montecillo MD a Professional Corporation Internal Medicine CurrentSince Jan 1, 2005 Accepting new patients
Cedars-Sinai Marina Hospital Past Accepting new patients

Locations

645 Aerick St
Ste 1
Inglewood, CA 90301
Phone (310) 673-2764

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
N/aInglewood, CA, CCN 555368 Skilled nursing facility Contracted Managing Employee
Adp of the SNF		 Mar 8, 2013
Jan 23, 2025
Homereach HospiceSignal Hill, CA, CCN 051731 Hospice Operational/Managerial Control Jun 1, 2012

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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.

Hospital & facility affiliations 7

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": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1447348149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 HIGH LN",
            "city": "REDONDO BEACH",
            "state": "CA",
            "postal_code": "902785107",
            "telephone_number": "310-673-2764",
            "fax_number": "310-673-2403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "645 AERICK ST",
            "address_2": "SUITE 1",
            "city": "INGLEWOOD",
            "state": "CA",
            "postal_code": "903014881",
            "telephone_number": "310-673-2764",
            "fax_number": "310-673-2403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTECILLO",
        "first_name": "LUZVIMINDA",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-10",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A52290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A522900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Inglewood, CA

Sources for this page

Verify at the official NPI Registry.