Individual provider Active NPI

Vincent Manuel Tristan, PA

  • Physician Assistant
  • Los Angeles, CA
National Provider Identifier
1598716151
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA13719 Issued in CA
Practice address
1510 San Pablo St
2ND Floor
Los Angeles, CA 90033-5320
Phone
(323) 442-5908
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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 PA13719 CA Primary

Addresses

Primary practice location

1510 San Pablo St
2ND Floor
Los Angeles, CA 90033-5320

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-5908

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vincent.tristan@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

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
I20061004000357 CA Practitioner - Physician Assistant 6103822705 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Usc Care Medical Group IncGroup PAC ID 0446157747, 1,378 clinicians

Practice addresses (Care Compare)

1500 San Pablo St
Los Angeles, CA 90033-5313
Phone (323) 442-8444

1516 San Pablo St
Los Angeles, CA 90033-5313
Phone (800) 872-2273

1520 San Pablo St
Los Angeles, CA 90033-5310
Phone (800) 872-2273

1520 San Pablo St 1St Floor N
Los Angeles, CA 90033-5310
Phone (800) 872-2273

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
13719CAMDAddiction (Substance Use Disorder) Counselor
PA13719CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California CurrentSince May 1, 2016 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Nov 1, 2016 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Nov 1, 2016 Accepting new patients

Locations

210 W San Bernardino Rd
Covina, CA 91723
Phone (626) 858-8580

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1510 San Pablo St
Fl 2
Los Angeles, CA 90033
Phone (323) 442-5908

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

1115 S Sunset Ave
West Covina, CA 91790
Phone (626) 814-2434

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: vincent.tristan@direct.usc.edu

Organizations & group practices 5

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.

Hospital & facility affiliations 3

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1598716151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1510 SAN PABLO ST",
            "address_2": "2ND FLOOR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335320",
            "telephone_number": "323-442-5908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRISTAN",
        "first_name": "VINCENT",
        "middle_name": "MANUEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA13719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vincent.tristan@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1510 San Pablo St",
            "address_2": "2nd Floor",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335320",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.