Imperial Valley Family Care Medical Group, Apc
Organization Active NPI Cardiac Rehabilitation Registered Nurse · Imperial, CA
NPI 1750112587 · NPPES record last updated Oct 15, 2024
Key facts
- NPI
- 1750112587
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiac Rehabilitation Registered Nurse 163WC3500X
- Legal business name
- IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC
- Practice address
- 516 West Aten Road
Suite 1
Imperial, CA 92251-9805 - Phone
- (760) 355-8300
- Fax
- (760) 545-0240
- NPI assigned
- Aug 13, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC
Authorized official
- Name
- Vachaspathi Palakodeti, MD
- Title
- Authorized Representative
- Phone
- (760) 355-8300
Parent organization (reported in NPPES) 1
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 3
Practitioners 81
-
Sam Baradarian, M.D.
-
Mohsen M El Ramah, M.D.
-
Jaime E Estrada, MD
-
Elana Godebu, M.D.
-
Vijaykanth Mahendrakar, M.D.
-
Farshad Raissi Shabari, M.D., M.P.H.
-
Yong Tan, M.D.
-
David Torres Barba, M.D., PHD
-
Patrick Wolcott, MD
-
Alidad M. Zadeh, D.O.
-
Richard Fitzsimmons, FNP
-
Elias N Moukarzel, M.D.
-
Alheli Arce Gastelum, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Imperial Valley Family Care Medical Group a P C |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Oct 1, 1995 Oct 1, 1995 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241127004223 | CA | Part B Supplier - Intensive Cardiac Rehabilitation | 0446243083 | Practice locations: Imperial, CA |
National Provider Directory
- Tax ID family
- Rehm Ken
- Part of
- Rehm Ken
Locations
608 G St
Ste 1A
Brawley, CA 92227
Phone (760) 344-2445
751 W Legion Rd
Ste 102
Brawley, CA 92227
Phone (760) 351-8696
608 G St
Ste A
Brawley, CA 92227
Phone (760) 351-1011
1665 S Imperial Ave
Ste B
El Centro, CA 92243
Phone (760) 312-5900
1600 S Imperial Ave
Ste 1
El Centro, CA 92243
Phone (619) 962-9620
1503 N Imperial Ave
Ste 105B
El Centro, CA 92243
Phone (760) 337-4100
529 Pine Ave
Holtville, CA 92250
Phone (760) 756-3112
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiac Rehabilitation Registered Nurse |
163WC3500X | Yes |
Addresses
Primary practice location
516 West Aten Road
Suite 1
Imperial, CA 92251-9805
Mailing address
516 West Aten Road
Suite 2
Imperial, CA 92251-9805
Phone (760) 355-7730
Other providers in Imperial, CA
- Imperial County Local Health Authority
- Imperial Manor Skilled Nursing Inc
- Imperial Usd
- Imperial Valley Family Care Medical Group
- Imperial Valley Family Care Medical Group Apc
- Imperial Valley Sleep Disorders
- Kristal Jaime
- Matthew John Jaime
- Samantha Jimenez
- Charisma Shauntae Johnson
All providers in Imperial, CA · Cardiac Rehabilitation Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 15, 2024. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.