Individual provider Active NPI

Ezra Eberhart

  • Case Manager/Care Coordinator
  • Camarillo, CA
National Provider Identifier
1790560308
Registry record updated Dec 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
3601 Calle Tecate Ste 200
Camarillo, CA 93012-5058
Phone
(805) 289-0120
NPI assigned
Aug 30, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X Primary

Addresses

Primary practice location

3601 Calle Tecate Ste 200
Camarillo, CA 93012-5058

Mailing address

3601 Calle Tecate Ste 200
Camarillo, CA 93012-5058
Phone (805) 289-0120

Other identifiers 1

IdentifierTypeStateIssuer
56CCOtherCAASPIRA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Aspira Foster & Family Services - Ventura Case Manager/Care Coordinator PastSince Sep 1, 2023 Accepting new patients

Organizations & group practices 1

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": "1693353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701820800000",
    "number": "1790560308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3601 CALLE TECATE STE 200",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125058",
            "telephone_number": "805-289-0120",
            "fax_number": "805-289-0130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 CALLE TECATE STE 200",
            "city": "CAMARILLO",
            "state": "CA",
            "postal_code": "930125058",
            "telephone_number": "805-289-0120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERHART",
        "first_name": "EZRA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-30",
        "last_updated": "2023-12-06",
        "certification_date": "2023-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASPIRA",
            "identifier": "56CC",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Camarillo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.