Charmaine Yolanda Collins-Cepeda, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA13542 Issued in CA

Practice address

1151 E Walnut St
Ontario, CA 91761-6155

Phone

(909) 620-7769

Fax

(877) 778-8097

NPI assigned

May 27, 2008

Last updated

Mar 30, 2018By the provider in NPPES

Sex

Female

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 8

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Unicare Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Riverside, CA
  • NPI 1639066491
  Medicare reassignment
• Unicare Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Moreno Valley, CA
  • NPI 1881151827
  NPD
• Unicare Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Huntington Park, CA
  • NPI 1871484618
  NPD
• Joseph M Molina MD Professional Corporation - Southern California

  dba Golden Shore Medical Group

  • Obstetrics & Gynecology Physician
  • Ontario, CA
  • NPI 1710478177
  NPD (past)
• Joseph M Molina MD Professional Corporation-Southern California

  • Family Medicine Physician
  • Wilmington, CA
  • NPI 1982976692
  NPD (past)

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

{
    "created_epoch": "1211846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522368000000",
    "number": "1801054820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 FAIR OAKS AVE STE 270",
            "city": "SOUTH PASADENA",
            "state": "CA",
            "postal_code": "910305801",
            "telephone_number": "626-346-2455",
            "fax_number": "626-639-3005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 E WALNUT ST",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917616155",
            "telephone_number": "909-620-7769",
            "fax_number": "877-778-8097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS-CEPEDA",
        "first_name": "CHARMAINE",
        "middle_name": "YOLANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-27",
        "last_updated": "2018-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "03735",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA13542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EFF: 1/18/13-ONTARIO",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EFF:2/20/13-ADELANTO",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EFF: 1/18/13-POMONA",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EFF: 02/20/13-MORENO",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EFF:2/20/13-NORIVERS",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL",
            "identifier": "PA13542 EFF: 6/4/12",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10/1/2012 - SAN BERN",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01272679/DU4034",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Martinez Coles
• Collaborative Autism Management Programs Inc.
• Beverly Collantes
• Collective Assessments
• Keyna Collier
• Alyssa Collins
• Eryn Collins
• Leilani Rose Colvert
• Javon Comas
• Sara Sheree Comeaux

• Physician Assistant in Ontario, CA
• Providers in Ontario, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.