NPIMap

Organization Active NPI

El Centro Regional Medical Center

Doing business as Calexico Outpatient Center

  • Rural Health Clinic/Center
  • Calexico, CA
National Provider Identifier
1598840258
Registry record updated Feb 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EL CENTRO REGIONAL MEDICAL CENTER
Doing business as
Calexico Outpatient Center
Practice address
495 E Birch St Ste a
Calexico, CA 92231-2374
Phone
(760) 357-0508
NPI assigned
Oct 25, 2006
Last updated
Feb 7, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2019

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

Authorized official

Name
Tisha Irene Benavidez
Title
Patient Financial Services Director
Phone
(760) 482-5334

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

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 names 1

  • Calexico Outpatient Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100513000723 CA Part A Provider - Rural Health Clinic 6901986397 Practice locations: Calexico, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598840258. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
495 E Birch St
Ste a
Calexico, CA 92231-2374
Related CCNs
050045

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
El Centro Reg Med Ctr3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

15990 Tuscola Rd
Apple Valley, CA 92307
Phone (760) 242-4808

608 G St
Ste 2A
Brawley, CA 92227
Phone (760) 351-2127

1001 Blair Ave
Ste 1
Calexico, CA 92231

223 W Cole Blvd
Calexico, CA 92231
Phone (760) 357-2020

401 E Birch St
Ste A
Calexico, CA 92231
Phone (760) 768-5246

495 E Birch St
Ste A
Calexico, CA 92231
Phone (760) 357-0508

1452 S La Brucherie Rd
#A
El Centro, CA 92243

1498 S La Brucherie Rd
#A
El Centro, CA 92243
Phone (619) 425-7755

1550 N Imperial Ave
Ste 1
El Centro, CA 92243
Phone (760) 352-1731

1955 Citracado Pkwy
Ste 200
Escondido, CA 92029
Phone (760) 489-1355

2421 Marshall Ave
Imperial, CA 92251

2363 Ulric St
Ste B
San Diego, CA 92111
Phone (858) 268-1747

3444 Kearny Villa Rd
Ste 201
San Diego, CA 92123
Phone (858) 430-1101

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Regents of the University of California Organization, San Diego, CA Corporation, Non-profit Operational/Managerial Control Jan 1, 2016 100%
Pablo Velez Individual Corporate OfficerChief Executive Officer Apr 17, 2023 100%
W-2 Managing EmployeeAd; Apr 17, 2023 100%
City of El Centro Organization, El Centro, CA 5% Or Greater Direct Ownership Interest Apr 13, 1966 100%

Owners & managing parties with NPI records 9

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 4

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 97

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549497600000",
    "number": "1598840258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 ROSS AVE",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922434306",
            "telephone_number": "760-339-7495",
            "fax_number": "760-339-7389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "495 E BIRCH ST STE A",
            "city": "CALEXICO",
            "state": "CA",
            "postal_code": "922312374",
            "telephone_number": "760-357-0508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EL CENTRO REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-25",
        "last_updated": "2019-02-07",
        "status": "A",
        "authorized_official_last_name": "BENAVIDEZ",
        "authorized_official_first_name": "TISHA",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "PATIENT FINANCIAL SERVICES DIRECTOR",
        "authorized_official_telephone_number": "760-482-5334"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CALEXICO OUTPATIENT CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Calexico Outpatient Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Calexico, CA

Sources for this page

Verify at the official NPI Registry.