Individual provider Active NPI

Edgar Ernesto Vargas, PA

  • Physician Assistant
  • Loma Linda, CA
National Provider Identifier
1689909046
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA20567 Issued in CA
Practice address
11666 Cedar St
Loma Linda, CA 92354-3606
Phone
(707) 322-4980
NPI assigned
Oct 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA20567 CA Primary

Addresses

Primary practice location

11666 Cedar St
Loma Linda, CA 92354-3606

Mailing address

11666 Cedar St
Loma Linda, CA 92354-3606
Phone (707) 322-4980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091216000031 CA Practitioner - Physician Assistant 1557401957 Reassigns benefits to 6 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA20567CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kaweah Delta Health Care District CurrentSince Sep 1, 2017 Accepting new patients
Cep America - California CurrentSince Aug 2, 2017 Accepting new patients
Kaweah Delta Health Care District CurrentSince Sep 1, 2017 Accepting new patients
Kaweah Delta Health Care District CurrentSince Sep 1, 2017 Accepting new patients
Cep America-California CurrentSince Oct 1, 2013 Accepting new patients
Front Line Emergency Care Spec Past Accepting new patients
Cep America - California Past Accepting new patients

Locations

18300 US Highway 18
Apple Valley, CA 92307
Phone (760) 424-2311

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

3630 E Imperial Hwy
Lynwood, CA 90262
Phone (310) 900-7420

726 4th St
Marysville, CA 95901
Phone (530) 491-9491

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

15031 Rinaldi St
San Fernando, CA 91345
Phone (818) 365-8051

400 W Mineral King Ave
Visalia, CA 93291
Phone (559) 624-2001

840 S Akers St
Visalia, CA 93277
Phone (559) 624-3700

1633 S Court St
Visalia, CA 93277
Phone (559) 624-6090

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1254441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1689909046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11666 CEDAR ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543606",
            "telephone_number": "707-322-4980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11666 CEDAR ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543606",
            "telephone_number": "707-322-4980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VARGAS",
        "first_name": "EDGAR",
        "middle_name": "ERNESTO",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-02",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA20567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

Verify at the official NPI Registry.