Individual provider Active NPI

Manuel Tovar, PA

  • Physician Assistant
  • Indio, CA
National Provider Identifier
1497018584
Registry record updated Aug 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
22256 Issued in CA
Practice address
82013 Doctor Carreon Blvd
Suite M
Indio, CA 92201-4832
Phone
(760) 342-4242
Fax
(760) 342-4233
NPI assigned
Jun 22, 2012
Last updated
Aug 30, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 22256 CA Primary

Addresses

Primary practice location

82013 Doctor Carreon Blvd
Suite M
Indio, CA 92201-4832

Mailing address

81709 Dr Carreon Blvd Ste D2
Indio, CA 92201-5578
Phone (760) 625-0545

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150120000354 CA Practitioner - Physician Assistant 9133443286 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

81709 Dr Carreon Blvd
Suite D2
Indio, CA 92201-5578
Phone (760) 625-0545

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
22256CAMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Robert O. Flores, M.D. Inc. Past Accepting new patients

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1340323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661817600000",
    "number": "1497018584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "81709 DR CARREON BLVD STE D2",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922015578",
            "telephone_number": "760-625-0545",
            "fax_number": "760-625-0546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82013 DOCTOR CARREON BLVD",
            "address_2": "SUITE M",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922014832",
            "telephone_number": "760-342-4242",
            "fax_number": "760-342-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOVAR",
        "first_name": "MANUEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-22",
        "last_updated": "2022-08-30",
        "certification_date": "2022-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "22256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indio, CA

Sources for this page

Verify at the official NPI Registry.