St Martin High Desert

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

ST MARTIN HIGH DESERT

Practice address

15475 Seneca Rd Ste a
Victorville, CA 92392-2299

Phone

(442) 255-4992

Fax

(442) 255-4993

NPI assigned

Nov 11, 2020

Last updated

Apr 4, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Veronica Vazquez

Title

Ceo

Phone

(442) 255-4992

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639771017. Details of each certification follow.

• CCN B31724 Hospice · Active · Details

Hospice certification: CCN B31724

Legal name

ST MARTIN HIGH DESERT

Certification status

Active

Provider type (POS)

Hospice

Participating since

Mar 4, 2022

Last certification

Mar 4, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Oct 21, 2020 in CA

Enrollment address

15475 Seneca Rd
Ste a
Victorville, CA 92392-2299

Listed as

St Martin High DesertCCN B31724 · All quality measures

Certified

Mar 4, 2022

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

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

Practitioners 1

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.

• Carol Martinez

  • Social Worker
  • Inglewood, CA
  • NPI 1396166450
  NPD

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Hari M. Reddy, M.D.

  • Family Medicine Physician
  • Victorville, CA
  • NPI 1811232911

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1605052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649030400000",
    "number": "1639771017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15475 SENECA RD STE A",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922299",
            "telephone_number": "760-881-9794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15475 SENECA RD STE A",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923922299",
            "telephone_number": "442-255-4992",
            "fax_number": "442-255-4993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARTIN HIGH DESERT",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-11",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "442-255-4992"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Victorville, CA
• Providers in Victorville, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.