Individual provider Active NPI

Kimberly Jocelyn Rubalcava

  • Marriage & Family Therapist
  • Las Vegas, NV
National Provider Identifier
1770042269
Registry record updated Mar 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Practice address
1640 Alta Dr Ste 4
Las Vegas, NV 89106-4165
Phone
(702) 474-6450
Fax
(702) 474-6463
NPI assigned
Mar 14, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X Primary

Addresses

Primary practice location

1640 Alta Dr Ste 4
Las Vegas, NV 89106-4165

Mailing address

1640 Alta Dr Ste 4
Las Vegas, NV 89106-4165
Phone (702) 474-6450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250313003697 NV Practitioner - Marriage and Family Therapist 3375065832 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bridge Counseling Associates IncGroup PAC ID 4486914975, 16 clinicians

Practice addresses (Care Compare)

4221 McLeod Dr
Las Vegas, NV 89121-5215
Phone (702) 474-6450

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bridge Counseling Associates, Inc CurrentSince Dec 15, 2024 Accepting new patients
Bridge Counseling Associates, Inc CurrentSince Dec 15, 2024 Accepting new patients

Locations

4221 McLeod Dr
Las Vegas, NV 89121
Phone (702) 474-6450

1640 Alta Dr
Ste 4
Las Vegas, NV 89106
Phone (702) 474-6450

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/f9a6475a-3dbd-47b2-979a-55064cfdbd51/

Organizations & group practices 2

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": "1552521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552521600000",
    "number": "1770042269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 ALTA DR STE 4",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064165",
            "telephone_number": "702-474-6450",
            "fax_number": "702-474-6463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 ALTA DR STE 4",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891064165",
            "telephone_number": "702-474-6450",
            "fax_number": "702-474-6463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUBALCAVA",
        "first_name": "KIMBERLY",
        "middle_name": "JOCELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-14",
        "last_updated": "2019-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.