NPIMap

Organization Active NPI

Imperial Valley Family Care Medical Group, Apc

  • Cardiac Rehabilitation Registered Nurse
  • Imperial, CA
National Provider Identifier
1750112587
Registry record updated Oct 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiac Rehabilitation Registered NurseTaxonomy code 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
Last updated
Oct 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 15, 2024

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

Authorized official

Name
Vachaspathi Palakodeti, MDNPI 1649224387
Title
Authorized Representative
Phone
(760) 355-8300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiac Rehabilitation Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WC3500X Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241127004223 CA Part B Supplier - Intensive Cardiac Rehabilitation 0446243083 Practice locations: Imperial, CA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
I V Family Care Medical4 organizations share this tax ID, including this one
Part of
I V Family Care Medical

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

125 S 5th St
Brawley, CA 92227
Phone (760) 344-8100

183 S 5th St
Brawley, CA 92227
Phone (760) 344-8100

608 G St
Ste 1A
Brawley, CA 92227
Phone (760) 344-2445

1503 N Imperial Ave
Ste 105B
El Centro, CA 92243
Phone (760) 337-4100

1550 N Imperial Ave
#12
El Centro, CA 92243
Phone (760) 353-4710

1600 S Imperial Ave
Ste 1
El Centro, CA 92243
Phone (619) 353-4710

1600 S Imperial Ave
Ste 5
El Centro, CA 92243
Phone (442) 283-5860

2109 Ross Ave
El Centro, CA 92243
Phone (760) 352-4103

790 W Orange Ave
Ste D
El Centro, CA 92243
Phone (760) 335-3545

612 S J St
Ste 7
Imperial, CA 92251
Phone (760) 355-8300

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Imperial Valley Family Care Medical Group a P CBrawley, CA, CCN 058984 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 1995
Oct 1, 1995

Owned or controlled facilities with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 86

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.

View all 86

NPI Registry JSON

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

{
    "created_epoch": "1723507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728950400000",
    "number": "1750112587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 WEST ATEN ROAD",
            "address_2": "SUITE 2",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "922519805",
            "telephone_number": "760-355-7730",
            "fax_number": "760-355-7731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 WEST ATEN ROAD",
            "address_2": "SUITE 1",
            "city": "IMPERIAL",
            "state": "CA",
            "postal_code": "922519805",
            "telephone_number": "760-355-8300",
            "fax_number": "760-545-0240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP, APC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IMPERIAL VALLEY FAMILY CARE MEDICAL GROUP APC",
        "enumeration_date": "2024-08-13",
        "last_updated": "2024-10-15",
        "status": "A",
        "authorized_official_last_name": "PALAKODETI",
        "authorized_official_first_name": "VACHASPATHI",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "760-355-8300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "163WC3500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Cardiac Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Imperial, CA

Sources for this page

Verify at the official NPI Registry.