NPIMap

Organization Active NPI

Pacifica Healthcare Providers LLC

  • General Practice Physician
  • Las Vegas, NV
National Provider Identifier
1528628633
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
PACIFICA HEALTHCARE PROVIDERS LLC
Practice address
2755 E Desert Inn Rd Ste 180
Las Vegas, NV 89121-3694
Phone
(702) 826-8889
NPI assigned
Jun 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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

Authorized official

Name
Claudia Avila
Title
Coo
Phone
(702) 826-8889

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103K00000X
General Practice PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208D00000X Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

2755 E Desert Inn Rd Ste 180
Las Vegas, NV 89121-3694

Mailing address

2755 E Desert Inn Rd Ste 180
Las Vegas, NV 89121-3694
Phone (702) 826-8889

Other identifiers 1

IdentifierTypeStateIssuer
250002866MedicaidNV

Other names 1

  • CiTi MD Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190729003618 NV Part B Supplier - Clinic/Group Practice 9638405624 Receives reassigned benefits from 12 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

3650 S Eastern Ave
Ste 330
Las Vegas, NV 89169
Phone (702) 524-9599

2785 E Desert Inn Rd
Ste 200
Las Vegas, NV 89121
Phone (702) 296-4844

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650585600000",
    "number": "1528628633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2755 E DESERT INN RD STE 180",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213694",
            "telephone_number": "702-826-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2755 E DESERT INN RD STE 180",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891213694",
            "telephone_number": "702-826-8889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICA HEALTHCARE PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-20",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A",
        "authorized_official_last_name": "AVILA",
        "authorized_official_first_name": "CLAUDIA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "702-826-8889"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250002866",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CiTi MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2022; 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.