NPIMap

Organization Active NPI

Imperial Valley Multi-Specialty Medical Group, Inc.

  • Specialist
  • El Centro, CA
National Provider Identifier
1700277647
Registry record updated Feb 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A113016 Issued in CA
Legal business name
IMPERIAL VALLEY MULTI-SPECIALTY MEDICAL GROUP, INC.
Practice address
2061 Ross Ave
Suite a
El Centro, CA 92243-3687
Phone
(908) 361-0185
NPI assigned
Feb 13, 2015
Last updated
Feb 13, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2015

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

Authorized official

Name
Dr. Sivaraman K Gounder, M.D.
Title
Secretary
Phone
(908) 361-0185

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A113016 CA Primary

Addresses

Primary practice location

2061 Ross Ave
Suite a
El Centro, CA 92243-3687

Mailing address

2061 Ross Ave
Suite a
El Centro, CA 92243-3687
Phone (908) 361-0185

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151016002173 CA Part B Supplier - Clinic/Group Practice 6406165281 Receives reassigned benefits from 11 practitioners
Practice locations: El Centro, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423785600000",
    "number": "1700277647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2061 ROSS AVE",
            "address_2": "SUITE A",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922433687",
            "telephone_number": "908-361-0185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2061 ROSS AVE",
            "address_2": "SUITE A",
            "city": "EL CENTRO",
            "state": "CA",
            "postal_code": "922433687",
            "telephone_number": "908-361-0185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL VALLEY MULTI-SPECIALTY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-13",
        "last_updated": "2015-02-13",
        "status": "A",
        "authorized_official_last_name": "GOUNDER",
        "authorized_official_first_name": "SIVARAMAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "908-361-0185",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A113016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Centro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.