El Centro Regional Medical Center
Organization Active NPI Rural Health Clinic/Center · Calexico, CA
NPI 1598840258 · NPPES record last updated Feb 7, 2019
Key facts
- NPI
- 1598840258
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- EL CENTRO REGIONAL MEDICAL CENTER
- Practice address
- 495 E Birch St Ste a
Calexico, CA 92231-2374 - Phone
- (760) 357-0508
- NPI assigned
- Oct 25, 2006
- Organization subpart
- No
Authorized official
- Name
- Tisha Irene Benavidez
- Title
- Patient Financial Services Director
- Phone
- (760) 482-5334
Owners & managing parties with NPI records 9
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Related certifications (CCN) 1
Facilities with the same owner 4
Practitioners 97
-
James M Kohan, MD
-
Theodore Affue, M.D.
-
Masoud Afshar, M.D.
-
Veerinder S. Anand, M.D.
-
Athar Masood Ansari, M.D.
-
Natalia Babkina, MD
-
Colin Bacorn, MD
-
Ramin Seyed Berenji, M.D.
-
Alaa Beydoun, M.D.
-
Hanh M Bui, M.D.
-
Luis C. Cajas-Monson, M.D.
-
Arnett Carraby, MD
-
Samantha Castro, FNP
-
Marc K Dao, MD
-
Viet Trong Dao, M.D.
-
Paul Edward Dato, M.D.
-
Tayson Delengocky, D.O
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Rural health clinic certification: CCN 058536
- Legal name
- EL CENTRO REGIONAL MEDICAL CENTER
- Doing business as
- CALEXICO OUTPATIENT CENTER
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 24, 1996
- Last certification
- Mar 28, 2013
- Ownership / control type
- Non-profit – church related
- Organization structure
- Government · Non-profit
- Enrollment address
- 495 E Birch St
Ste a
Calexico, CA 92231-2374 - Related CCNs
- 050045
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Regents of the University of California |
Operational/Managerial Control | Jan 1, 2016 | 100% |
| Pablo Velez |
Corporate Officer |
Apr 17, 2023 | 100% |
| W-2 Managing Employee |
Apr 17, 2023 | 100% | |
| City of El Centro |
5% Or Greater Direct Ownership Interest | Apr 13, 1966 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100513000723 | CA | Part a Provider - Rural Health Clinic | 6901986397 | Practice locations: Calexico, CA |
National Provider Directory
- Tax ID family
- El Centro Reg Med Ctr
Locations
608 G St
Ste 2A
Brawley, CA 92227
Phone (760) 351-2127
1001 Blair Ave
Ste 1
Calexico, CA 92231
495 E Birch St
Ste A
Calexico, CA 92231
Phone (760) 357-0508
1503 N Imperial Ave
Ste 203
El Centro, CA 92243
Phone (760) 352-5067
1498 S La Brucherie Rd
#A
El Centro, CA 92243
Phone (619) 425-7755
1550 N Imperial Ave
Ste 2
El Centro, CA 92243
Phone (760) 353-5000
2421 Marshall Ave
Imperial, CA 92251
11332 Mountain View Ave
Ste D
Loma Linda, CA 92354
Phone (909) 496-3287
2131 3rd Ave
Ste 300
San Diego, CA 92101
3444 Kearny Villa Rd
Ste 201
San Diego, CA 92123
Phone (858) 430-1101
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
495 E Birch St Ste a
Calexico, CA 92231-2374
Mailing address
1415 Ross Ave
El Centro, CA 92243-4306
Phone (760) 339-7495
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RHM18536F | Medicaid | CA |
Other names
- Calexico Outpatient Center
Other providers in Calexico, CA
- Man Cong Duong
- Easyaccess Care Ipa, Inc.
- Easyaccess Medical Group, Inc
- Eepf LLC
- Eggleton & Langton Physical Therapy Management Services
- Emcs Healthcare of Imperial County a JD Weilbacker DO Company
- Aaron Equihua
- Jesus Equihua
- Angely Espinoza
- Daniel Espinoza
All providers in Calexico, CA · Rural Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 7, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.