Carmen Cabailo Briones, MD
Individual provider Active NPI Pediatrics Physician · Aberdeen, WA
NPI 1700965753 · NPPES record last updated Jun 1, 2020
Key facts
- NPI
- 1700965753
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 52752 (MN)
- Practice address
- 615 North F Street
Aberdeen, WA 98520 - Phone
- (360) 533-4599
- Fax
- (360) 537-6514
- NPI assigned
- Nov 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210623004026 | CA | Practitioner - Pediatric Medicine | 6305033895 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 52752 | MN | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ridgecrest Regional Hospital | Current |
Accepting new patients | |
| Ridgecrest Regional Hospital | Current |
Accepting new patients | |
| Lancaster Hospital Corporation | Past | Accepting new patients | |
| City of Wheaton | Past | Accepting new patients | |
| Valley Children'S Medical Group | Pediatrics | Past | Accepting new patients |
| Sanford Bismarck | Past | Accepting new patients |
Locations
1111 N China Lake Blvd
Ridgecrest, CA 93555
Phone (760) 446-4571
1081 N China Lake Blvd
Ridgecrest, CA 93555
Phone (760) 446-0616
1111 N China Lake Blvd
#190
Ridgecrest, CA 93555
Phone (760) 499-3855
Interoperability endpoints
- carmenbriones@rrh.medalliesdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 52752 | MN | Yes |
Addresses
Primary practice location
615 North F Street
Aberdeen, WA 98520
Mailing address
PO Box 5074
Sioux Falls, SD 57117-5074
Phone (218) 333-5000
Other practice location 1
1300 Anne St NW
Bemidji, MN 56601
Phone (218) 333-5000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700965753 | Medicaid | MN |
Other providers in Aberdeen, WA
- Robert E Boyle Jr.
- Veronica Xena Rose Bradley
- Jiana Marie Brandt
- Dana A. Brannon
- Arielle N Brasel
- Broadway Clinic Inc
- Matti Chloe Brockhoff
- Barbara Brodkowitz
- Michael William Bromley
- Richard Paul Brooks Jr.
All providers in Aberdeen, WA · Pediatrics Physician in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.