Centro Medico del Carmen

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

A52193 Issued in CA

Legal business name

CENTRO MEDICO DEL CARMEN

Practice address

13373 Perris Blvd
Suite C202A
Moreno Valley, CA 92553-5441

Phone

(951) 242-8155

Fax

(951) 242-8311

NPI assigned

Dec 14, 2016

Last updated

Dec 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ana Rosa Ascencio, CLEC.MA

Title

Administrative Assistant

Phone

(213) 219-8054

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Centro Medico del Carmen, a Medical Corporation

  • General Practice Physician
  • Escondido, CA
  • NPI 1063621738

  O20060314000710

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11763/brand/1/csg/1/fhir/r4

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Lee Watson, M.D.

  • General Practice Physician
  • Escondido, CA
  • NPI 1104865781
  NPD

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

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481673600000",
    "number": "1821532508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13373 PERRIS BLVD",
            "address_2": "SUITE C202A",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535441",
            "telephone_number": "951-242-8155",
            "fax_number": "951-242-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13373 PERRIS BLVD",
            "address_2": "SUITE C202A",
            "city": "MORENO VALLEY",
            "state": "CA",
            "postal_code": "925535441",
            "telephone_number": "951-242-8155",
            "fax_number": "951-242-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRO MEDICO DEL CARMEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-14",
        "last_updated": "2016-12-14",
        "status": "A",
        "authorized_official_last_name": "ASCENCIO",
        "authorized_official_first_name": "ANA",
        "authorized_official_middle_name": "ROSA",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "213-219-8054",
        "authorized_official_credential": "CLEC.MA"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "A52193",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00521930",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID:",
            "identifier": "W19646",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Ceja Manzo
• Celestial Senior Living LLC
• Brandon Cendejas, PA-C
• Crystal Cendejas, MSW, LCSW
• Central Occupational Medicine Providers - Ontario, a Medical Corporati
• Cep America - California (Vituity)
• Cep America - California (Vituity)
• Jorge David Cervantes, DDS
• Leah Maribell Cervantes
• Cesario Dayahan MD Inc

• General Practice Physician in Moreno Valley, CA
• Providers in Moreno Valley, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.