NPIMap

Individual provider Active NPI

Ricardo Davalos, M.D.

  • Family Medicine Physician
  • San Clemente, CA
National Provider Identifier
1609804749
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A65157 Issued in CA
Practice address
150 Avenida Cabrillo
Suite #a
San Clemente, CA 92627
Phone
(949) 369-6993
Fax
(949) 369-6469
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A65157 CA Primary

Addresses

Primary practice location

150 Avenida Cabrillo
Suite #a
San Clemente, CA 92627

Mailing address

150 Avenida Cabrillo
Suite #a
San Clemente, CA 92627
Phone (949) 369-6993

Other identifiers 2

IdentifierTypeStateIssuer
A65157OtherCASTATE LIC
00A651570MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120223000123 CA Practitioner - Family Practice 1951214709 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Southern California Keck School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

150 Avenida Cabrillo a
San Clemente, CA 92672-5595
Phone (949) 369-6993

Hospital & facility affiliations

  • Providence at Home With Compassus Home Health, Orange County South Home health agency, Irvine, CA, CCN 058238
  • Apex Home Health Care Services Home health agency, Santa Ana, CA, CCN 058341
  • Memorialcare Saddleback Medical Center Hospital, Laguna Hills, CA, CCN 050603
  • Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224
  • Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Private Practice Network Inc Family Medicine CurrentSince Jul 8, 2017 Accepting new patients
Ocean Breeze Medical Group, Inc. Family Medicine CurrentSince Aug 23, 1999 Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
MD Solutions Medical Corp Past Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Children'S Hospital at Mission Past Accepting new patients

Locations

150 Avenida Cabrillo
Ste A
San Clemente, CA 92672
Phone (949) 369-6993

30230 Rancho Viejo Rd
Ste 110
San Juan Capo, CA 92675
Phone (949) 441-5681

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: ricardo.davalos.p28@direct.monarchhealthcare.nextgenshare.com
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

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 6

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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1609804749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 AVENIDA CABRILLO",
            "address_2": "SUITE #A",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "92627",
            "telephone_number": "949-369-6993",
            "fax_number": "949-369-6469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 AVENIDA CABRILLO",
            "address_2": "SUITE #A",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "92627",
            "telephone_number": "949-369-6993",
            "fax_number": "949-369-6469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVALOS",
        "first_name": "RICARDO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A65157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LIC",
            "identifier": "A65157",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A651570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Clemente, CA

Sources for this page

Verify at the official NPI Registry.