Juan Carlos Pequeno, MD

Primary specialty

Addiction Psychiatry PhysicianTaxonomy code 2084P0802X

License

A61571 Issued in CA

Practice address

1600 Bailey Ave Ste 2
Needles, CA 92363-3105

Phone

(760) 326-9313

Fax

(760) 326-2864

NPI assigned

Nov 30, 2005

Last updated

Dec 21, 2020By the provider in NPPES

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

Other, 1986

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

County of San BernardinoGroup PAC ID 3870499130, 76 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Colorado River Medical Center Hospital, Needles, CA, CCN 051323

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• County of San Bernardino

  dba Department of Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • San Bernardino, CA
  • NPI 1164467023
  Medicare reassignment Care Compare group NPD
• County of San Bernardino

  dba Apple Valley Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Apple Valley, CA
  • NPI 1346950904
  NPD
• County of San Bernardino

  dba Barstow Counseling Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Barstow, CA
  • NPI 1992913511
  NPD
• County of San Bernardino

  dba Needles Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Needles, CA
  • NPI 1508075805
  NPD (past)
• Mohave Primary Care

  • Specialist
  • Kingman, AZ
  • NPI 1700909330
  NPD (past)
• Sycamore Avenue Medical Center, PLLC

  • Family Nurse Practitioner
  • Kingman, AZ
  • NPI 1245762491
  NPD (past)

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

• Community Healthcare Partner, Inc

  dba Colorado River Medical Center

  • Critical Access Hospital
  • Needles, CA
  • NPI 1457520942
  Care Compare affiliation

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1477537942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 E VANDERBILT WAY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924150026",
            "telephone_number": "909-388-0806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 BAILEY AVE STE 2",
            "city": "NEEDLES",
            "state": "CA",
            "postal_code": "923633105",
            "telephone_number": "760-326-9313",
            "fax_number": "760-326-2864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEQUENO",
        "first_name": "JUAN",
        "middle_name": "CARLOS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "AZ",
            "license": "AZ28640",
            "primary": false
        },
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "CA",
            "license": "A61571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Needles Hospice, Inc.
• Needles Hospital, Inc (none)
• Needles Medical Management Center Inc (Tri-State Home Health Services)
• Pacific Clinics
• Mistydae Paget
• Czarina Lim Perello, MSN-FNP
• Jason Dean Phillips, SUDCC-II 6264
• Premier Emergency Physicians of California Medical Group PC
• Principal-Needles Inc (Colorado River Medical Center)
• Principal-Needles Inc

• Addiction Psychiatry Physician in Needles, CA
• Providers in Needles, CA by specialty
• Addiction Psychiatry Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.