Elliana Ixta Madera

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

103120 Issued in CA

Practice address

509 E Rosecrans Ave
Compton, CA 90221

Phone

(213) 385-5100

NPI assigned

Aug 21, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Blue Moon Senior Counseling of California LLC

  • Clinical Social Worker
  • Plainfield, IL
  • NPI 1447678990

  CA

  Medicare reassignment NPD

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

{
    "created_epoch": "1377043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629331200000",
    "number": "1922432319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 E ROSECRANS AVE",
            "city": "COMPTON",
            "state": "CA",
            "postal_code": "902212056",
            "telephone_number": "213-385-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 E ROSECRANS AVE",
            "city": "COMPTON",
            "state": "CA",
            "postal_code": "90221",
            "telephone_number": "213-385-5100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "649 E Albertoni St",
            "address_purpose": "LOCATION",
            "city": "Carson",
            "state": "CA",
            "postal_code": "907461538",
            "country_code": "US",
            "telephone_number": "310-436-9300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IXTA MADERA",
        "first_name": "ELLIANA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-21",
        "last_updated": "2021-08-19",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "63242",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "63242",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "103120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Intra Drugs Artesia
• Abdul Islam
• Nimat Islam
• Ronnie Islam
• Zakiyyah Iman Islam
• Dwaine Jackson
• Shannon Jackson, RN
• Victoria Maria Jacquez
• Margarita Jaime
• Mohsen N/a Jamei, MD

• Clinical Social Worker in Compton, CA
• Providers in Compton, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2021; 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.