NPIMap

Individual provider Active NPI

Sergio Cuevas, DDS

  • Dentist
  • San Ysidro, CA
National Provider Identifier
1720181290
Registry record updated Mar 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
41007 Issued in CA
Practice address
4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone
(619) 428-4463
Fax
(619) 428-2625
NPI assigned
Sep 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 41007 CA Primary

Addresses

Primary practice location

4004 Beyer Blvd
San Ysidro, CA 92173-2007

Mailing address

4004 Beyer Blvd
San Ysidro, CA 92173-2007
Phone (619) 428-4463

Other identifiers 1

IdentifierTypeStateIssuer
FHC18880FOtherMEDI-CAL

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
I20151007002326 CA Order and Referring Only - DentistPractitioner - Dentist 7214006840

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
41007CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Centro de Salud de la Comunidad de San Ysidro Inc PastSince Sep 2, 2008 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: scuevas18227@syhealth.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 12

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

FacilityTypeRoleSince
San Ysidro Health San Ysidro Health CenterSan Ysidro, CA, CCN 551809 Federally qualified health center Corporate Director May 7, 2001
San Ysidro Health National CityNational City, CA, CCN 551810 Federally qualified health center W-2 Managing Employee Sep 15, 1983
San Ysidro Health CHC-Ocean ViewSan Diego, CA, CCN 551920 Federally qualified health center W-2 Managing Employee Aug 25, 2008
San Ysidro Health EuclidSan Diego, CA, CCN 551922 Federally qualified health center W-2 Managing Employee Aug 25, 2008
San Ysidro Health Paradise HillsNational City, CA, CCN 551004 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Aug 24, 2009
Aug 24, 2009
San Ysidro Health OtayChula Vista, CA, CCN 551966 Federally qualified health center W-2 Managing Employee Mar 1, 2004
San Ysidro Health King-Huerta-Itliong Health CenterSan Diego, CA, CCN 551195 Federally qualified health center Corporate Director
W-2 Managing Employee		 May 7, 2001
May 7, 2001
San Ysidro Health Chula VistaChula Vista, CA, CCN 751024 Federally qualified health center Corporate Director May 7, 2001
San Ysidro Health El Cajon/San Diego PaceEl Cajon, CA, CCN 751822 Federally qualified health center W-2 Managing Employee May 7, 2001
San Ysidro Health South BayNational City, CA, CCN 751950 Federally qualified health center Corporate Officer
W-2 Managing Employee		 Mar 1, 2004
Mar 1, 2004
San Ysidro Health San Diego Pace/Senior Health Services Chula VistaChula Vista, CA, CCN 921899 Federally qualified health center Corporate Director Oct 20, 2012
San Ysidro Health San Diego Pace VistaVista, CA, CCN A01098 Federally qualified health center Corporate Director May 7, 2001

Owned or controlled facilities with NPI records 12

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

Organizations & group practices 1

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": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330560000000",
    "number": "1720181290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732007",
            "telephone_number": "619-428-4463",
            "fax_number": "619-428-2625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732007",
            "telephone_number": "619-428-4463",
            "fax_number": "619-428-2625"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUEVAS",
        "first_name": "SERGIO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2012-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "41007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "FHC18880F",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Ysidro, CA

Sources for this page

Verify at the official NPI Registry.