NPIMap

Individual provider Active NPI

Vachaspathi Palakodeti, MD

  • Cardiovascular Disease Physician
  • Imperial, CA
National Provider Identifier
1649224387
Registry record updated Dec 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A52484 Issued in CA
Practice address
516 West Aten Road
Suite 1
Imperial, CA 92251
Phone
(760) 355-8300
Fax
(760) 545-0240
NPI assigned
May 19, 2006
Last updated
Dec 19, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X A52484 CA Primary

Addresses

Primary practice location

516 West Aten Road
Suite 1
Imperial, CA 92251

Mailing address

516 West Aten Road
Suite 2
Imperial, CA 92251
Phone (760) 355-7730

Other identifiers 4

IdentifierTypeStateIssuer
ZZZ54781ZOtherCABLUE SHIELD OF CALIFORNIA
00A524840MedicaidCA
GR0066313OtherCAMEDI CAL GROUP NUMBER
WA52484JOtherCAMEDICARE PTAN

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
I20090522000242 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 1355334905 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Internal Medicine
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

516 W Aten Rd
Suite 1
Imperial, CA 92251-9805
Phone (760) 355-8300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A52484CAMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Imperial Valley Family Care Medical Group Apc CurrentSince Nov 1, 1997 Accepting new patients
Imperial Valley Family Care Medical Group, Apc CurrentSince Nov 1, 1997 Accepting new patients
El Centro Regional Medical Center CurrentSince Jun 5, 2011 Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Pioneers Memorial Healthcare District Past Accepting new patients
El Centro Regional Medical Center Past Accepting new patients

Locations

125 S 5th St
Brawley, CA 92227
Phone (760) 344-8100

207 W Legion Rd
Brawley, CA 92227
Phone (760) 351-3333

401 E Birch St
Ste C
Calexico, CA 92231
Phone (760) 355-8300

1415 Ross Ave
El Centro, CA 92243
Phone (760) 339-4045

1850 W Main St
Ste C
El Centro, CA 92243
Phone (760) 355-8300

516 W Aten Rd
Ste 1
Imperial, CA 92251
Phone (760) 355-7748

516 W Aten Rd
Ste 2
Imperial, CA 92251
Phone (760) 355-7730

612 S J St
Ste 7
Imperial, CA 92251
Phone (760) 355-8300

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Imperial Valley Family Care Medical Group a P CBrawley, CA, CCN 058984 Rural health clinic 5% Or Greater Direct Ownership Interest (11.12%)
Corporate Officer
W-2 Managing Employee		 Mar 1, 2000
Jan 1, 2007
Mar 1, 2000

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482105600000",
    "number": "1649224387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 WEST ATEN ROAD",
            "address_2": "SUITE 2",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "92251",
            "telephone_number": "760-355-7730",
            "fax_number": "760-355-7731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 WEST ATEN ROAD",
            "address_2": "SUITE 1",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "92251",
            "telephone_number": "760-355-8300",
            "fax_number": "760-545-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALAKODETI",
        "first_name": "VACHASPATHI",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2016-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A52484",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZ54781Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A524840",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI CAL GROUP NUMBER",
            "identifier": "GR0066313",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "WA52484J",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Imperial, CA

Sources for this page

Verify at the official NPI Registry.