NPIMap

Individual provider Active NPI

Eldine A Banquerigo, M.D.

  • Family Medicine Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1851367528
Registry record updated Nov 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A53530 Issued in CA
Practice address
8112 Milliken Ave Ste 100
Rancho Cucamonga, CA 91730-7472
Phone
(909) 466-6410
Fax
(909) 466-5667
NPI assigned
Feb 23, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 21, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A53530 CA Primary

Addresses

Primary practice location

8112 Milliken Ave Ste 100
Rancho Cucamonga, CA 91730-7472

Mailing address

8112 Milliken Ave Ste 100
Rancho Cucamonga, CA 91730-7472
Phone (909) 466-6410

Other identifiers 2

IdentifierTypeStateIssuer
00A535300MedicaidCA
33-0917177OtherCAFEDERAL TAX ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031209001124 CA Practitioner - Family Practice 2668378738 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rancho Cucamonga Perpetual Help Medical CorporationGroup PAC ID 1557329794, 2 clinicians

Practice addresses (Care Compare)

8112 Milliken Ave
Suite 100
Rancho Cucamonga, CA 91730-7471

8112 Milliken Ave
Suite 100
Rancho Cucamonga, CA 91730-7472
Phone (909) 466-6410

Hospital & facility affiliations

  • Santa Clarita Home Health Home health agency, Santa Clarita, CA, CCN 557722
  • Nuera Hospice, Inc Hospice, Canoga Park, CA, CCN B21783
  • Everclear Hospice & Palliative Care, Inc Hospice, Lomita, CA, CCN B41542
  • Graceful Palms Hospice and Palliative Care Corp. Hospice, Palmdale, CA, CCN 551644
  • Lighthouse Hospice Care, Inc. Hospice, Rancho Cucamonga, CA, CCN B51638
  • Serene Hospice Care, Inc Hospice, La Crescenta, CA, CCN 921661
  • San Antonio Regional Hospital Hospital, Upland, CA, CCN 050099

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A53530CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rancho Cucamonga Perpetual Help Medical Corporation Family Medicine CurrentSince Aug 27, 2013 Accepting new patients
Prime Healthcare Services - Montclair, LLC Past Accepting new patients
San Antonio Regional Hospital Past Accepting new patients
Primecare Medical Group Past Accepting new patients
Nuestra Angel Medical Center Inc Past Accepting new patients

Locations

8112 Milliken Ave
Ste 100
Rch Cucamonga, CA 91730
Phone (909) 466-6410

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1140652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479686400000",
    "number": "1851367528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8112 MILLIKEN AVE STE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307472",
            "telephone_number": "909-466-6410",
            "fax_number": "909-466-5667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8112 MILLIKEN AVE STE 100",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307472",
            "telephone_number": "909-466-6410",
            "fax_number": "909-466-5667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANQUERIGO",
        "first_name": "ELDINE",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-23",
        "last_updated": "2016-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A53530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A535300",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL TAX ID",
            "identifier": "33-0917177",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

Verify at the official NPI Registry.