Tivi Mauro, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA65136 Issued in CA

Practice address

3910 Ingraham St Apt 14-104
San Diego, CA 92109-5906

Phone

(716) 573-6333

NPI assigned

Oct 16, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kevin J Pelton MD IncGroup PAC ID 3375625486, 38 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Glendale Adventist Medical Center Hospital, Glendale, CA, CCN 050239
• Glendale Mem Hospital & HLTH Center Hospital, Glendale, CA, CCN 050058

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

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.

• Kevin J. Pelton MD, Inc.

  • Orthopaedic Surgery Physician
  • Los Angeles, CA
  • NPI 1679771703
  Medicare reassignment Care Compare group NPD
• Kevin J Pelton MD Inc

  • Durable Medical Equipment & Medical Supplies
  • Glendale, CA
  • NPI 1710764576
  NPD
• Kevin J. Pelton MD, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Santa Fe Springs, CA
  • NPI 1821711870
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dignity Community Care

  • General Acute Care Hospital
  • Glendale, CA
  • NPI 1477610640
  Care Compare affiliation
• Glendale Adventist Medical Center

  • General Acute Care Hospital
  • Glendale, CA
  • NPI 1831188275
  Care Compare affiliation

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

{
    "created_epoch": "1729036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729036800000",
    "number": "1770303323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3910 INGRAHAM ST APT 14-104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921095906",
            "telephone_number": "716-573-6333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3910 INGRAHAM ST APT 14-104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921095906",
            "telephone_number": "716-573-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAURO",
        "first_name": "TIVI",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-16",
        "last_updated": "2024-10-16",
        "certification_date": "2024-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA65136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maritess Mauricio, M.D.
• Richard Mauricio, RN
• Karolyn Rose Mauro, M.D.
• Patricia Elizabeth Mauro, PH.D.
• Tara Codee Mauro, D.O.
• Michael Kevin Maus, R.N.
• Timothy M Maus, M.D.
• Robert Edmund Mautte Jr.
• Darlene Mercy Mauze
• Meredith Mauze, LMFT

• Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.