Organization Active NPI

Spring Mountain Medical Center PLLC

  • Internal Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1639791791
Registry record updated Sep 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SPRING MOUNTAIN MEDICAL CENTER PLLC
Practice address
2810 W Charleston Blvd Ste G64
Las Vegas, NV 89102-1921
Phone
(702) 899-3039
NPI assigned
May 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2025

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

Authorized official

Name
Rafael Okamoto, MDNPI 1235281874
Title
Owner
Phone
(714) 376-7853

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

2810 W Charleston Blvd Ste G64
Las Vegas, NV 89102-1921

Mailing address

4276 Spring Mountain Rd Unit 211
Las Vegas, NV 89102-8781
Phone (702) 899-3039

Other identifiers 1

IdentifierTypeStateIssuer
1235281874MedicaidNV

Other names 1

  • RAFAEL OKAMOTO Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL OtherURL Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221213002806 NV Part B Supplier - Clinic/Group Practice 2365811312 Receives reassigned benefits from 1 practitioner
Practice locations: Las Vegas, NV

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
29D2275486Spring Mountain Medical Center2810 W Charleston Blvd Unit G64, Las Vegas, NV 89102Certificate of waiverJan 22, 2027

National Provider Directory

National Provider Directory

Locations

2810 W Charleston Blvd
Ste G64
Las Vegas, NV 89102
Phone (702) 889-3039

4276 Spring Mountain Rd
Unit 211
Las Vegas, NV 89102

2810 W Charleston Blvd
Unit G64
Las Vegas, NV 89102

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1589241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758931200000",
    "number": "1639791791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4276 SPRING MOUNTAIN RD UNIT 211",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891028781",
            "telephone_number": "702-899-3039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 W CHARLESTON BLVD STE G64",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891021921",
            "telephone_number": "702-899-3039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRING MOUNTAIN MEDICAL CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-12",
        "last_updated": "2025-09-27",
        "certification_date": "2025-09-27",
        "status": "A",
        "authorized_official_last_name": "OKAMOTO",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-376-7853",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1235281874",
            "state": "NV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "OtherURL",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "2810 W Charleston Blvd Ste G64",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891021921",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "RAFAEL OKAMOTO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.