Edwin G Ventocilla, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA16349 Issued in CA

Practice address

6339 Mack Rd
Sacramento, CA 95823-4655

Phone

(916) 454-2345

NPI assigned

Dec 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Elica Health Centers

  • Federally Qualified Health Center (FQHC)
  • West Sacramento, CA
  • NPI 1548425853
  Medicare reassignment
• Elica Health Centers

  • Federally Qualified Health Center (FQHC)
  • Sacramento, CA
  • NPI 1760293351
  NPD
• Palatnik Medical Corporation

  • Clinic/Center
  • Sacramento, CA
  • NPI 1891813085
  NPD (past)

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

{
    "created_epoch": "1165017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672963200000",
    "number": "1508934860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 HOWE AVE STE 440",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958251098",
            "telephone_number": "916-569-8484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6339 MACK RD",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958234655",
            "telephone_number": "916-454-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VENTOCILLA",
        "first_name": "EDWIN",
        "middle_name": "G",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-02",
        "last_updated": "2023-01-06",
        "certification_date": "2023-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA16349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DV5277-P01505494",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EFF 6/18/15",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janani Venkateswaran
• Champak Venkitachalam, MD, MPH
• Ruby Veno
• Alexander R. Vento, MD
• Angelita Ventocilla
• Angel Ventura Barrios
• Mayra Elizabeth Ventura Razo
• Alexander David Ventura
• Sara R Ventura
• Coury Venturi, RBT

• Physician Assistant in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.