NPIMap

Organization Active NPI

Anesthesia Medical Group of Imperial Valley, Inc.

  • Anesthesiology Physician
  • Brawley, CA
National Provider Identifier
1487087136
Registry record updated Jun 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ANESTHESIA MEDICAL GROUP OF IMPERIAL VALLEY, INC.
Practice address
207 W Legion Rd
Brawley, CA 92227-7780
Phone
(760) 351-3288
NPI assigned
Aug 16, 2013
Last updated
Jun 21, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2019

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

Authorized official

Name
Jaime Anthone Englea-Larra, DONPI 1962663286
Title
Group President
Phone
(760) 351-3288

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X

Addresses

Primary practice location

207 W Legion Rd
Brawley, CA 92227-7780

Mailing address

PO Box 7096
Stockton, CA 95267-0096
Phone (209) 956-7725

Other practice location 1

195 W Legion Rd
Brawley, CA 92227-7714
Phone (760) 351-8669

Other practice location 2

751 W Legion Rd Ste 103
Brawley, CA 92227-7754
Phone (760) 351-4100

Other practice location 3

2402 Imperial Business Park Dr Ste 101
Imperial, CA 92251-4004
Phone (760) 351-8669

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140303001946 CA Part B Supplier - Clinic/Group Practice 9335379775 Receives reassigned benefits from 33 practitioners
Practice locations: Brawley, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 36

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.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1376611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561075200000",
    "number": "1487087136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7096",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952670096",
            "telephone_number": "209-956-7725",
            "fax_number": "209-956-7733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 W LEGION RD",
            "city": "BRAWLEY",
            "state": "CA",
            "postal_code": "922277780",
            "telephone_number": "760-351-3288"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "195 W Legion Rd",
            "address_purpose": "LOCATION",
            "city": "Brawley",
            "state": "CA",
            "postal_code": "922277714",
            "country_code": "US",
            "telephone_number": "760-351-8669",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "751 W Legion Rd Ste 103",
            "address_purpose": "LOCATION",
            "city": "Brawley",
            "state": "CA",
            "postal_code": "922277754",
            "country_code": "US",
            "telephone_number": "760-351-4100",
            "fax_number": "760-351-4101",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2402 Imperial Business Park Dr Ste 101",
            "address_purpose": "LOCATION",
            "city": "Imperial",
            "state": "CA",
            "postal_code": "922514004",
            "country_code": "US",
            "telephone_number": "760-351-8669",
            "fax_number": "760-351-8994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ANESTHESIA MEDICAL GROUP OF IMPERIAL VALLEY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-16",
        "last_updated": "2019-06-21",
        "status": "A",
        "authorized_official_last_name": "ENGLEA-LARRA",
        "authorized_official_first_name": "JAIME",
        "authorized_official_middle_name": "ANTHONE",
        "authorized_official_title_or_position": "GROUP PRESIDENT",
        "authorized_official_telephone_number": "760-351-3288",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brawley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2019; 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.