Victor Rene Velasco Andrade, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

A162455 Issued in CA

Practice address

4733 W Sunset Blvd FL 3
Los Angeles, CA 90027-6021

Phone

(323) 783-4516

NPI assigned

May 19, 2015

Last updated

Dec 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric Medicine

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25390/brand/1/csg/1/fhir/r4
• Direct secure messaging: victor.velasco.1@25390.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Riverside, CA
  • NPI 1316979834
  Medicare reassignment Care Compare group NPD
• Velasco Medical Corp

  dba Velasco Pediatrics

  • Pediatrics Physician
  • Chula Vista, CA
  • NPI 1073277539
  NPD Authorized official
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Bakersfield, CA
  • NPI 1316572753
  NPD
• Regents of the Univ of Ca

  • Surgery Physician
  • Sacramento, CA
  • NPI 1427041698
  NPD (past)

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

{
    "created_epoch": "1431993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1760861009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2861 LYTTON CREEK CT",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919151625",
            "telephone_number": "310-242-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4733 W SUNSET BLVD FL 3",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900276021",
            "telephone_number": "323-783-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VELASCO ANDRADE",
        "first_name": "VICTOR",
        "middle_name": "RENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-19",
        "last_updated": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A162455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "N/A",
            "identifier": "N/A",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Justine Feliz Velandria
• Christina Velarde
• Daisy Mae Fajardo Velarde
• Raechel Lael Velarde
• Stephanie Velarde
• Diana Estefania Velasco Esqueda
• Jill Velasco Pena
• Wilfredo Antonio Velasco Vargas, RN
• Althea C. Velasco
• Angela Crystal Velasco

• Pediatrics Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.