Individual provider Active NPI

Carla Maria Peredo Alcid, MD

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • Orange, CA
National Provider Identifier
1942285507
Registry record updated Dec 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Emergency Medicine (Emergency Medicine) PhysicianTaxonomy code 207PP0204X
License
A52709 Issued in CA
Practice address
1201 W la Veta Ave
Orange, CA 92868-4203
Phone
(502) 541-2637
Fax
(949) 748-6664
NPI assigned
Dec 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2013

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 33113 KY
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 33113 KY
Pediatric Emergency Medicine (Pediatrics) Physician 2080P0204X 202409 LA
Pediatrics Physician 208000000X 202409 LA
Pediatric Emergency Medicine (Emergency Medicine) Physician 207PP0204X A52709 CA Primary

Addresses

Primary practice location

1201 W la Veta Ave
Orange, CA 92868-4203

Mailing address

1201 W la Veta Ave
Orange, CA 92868-4203
Phone (502) 541-2637

Other identifiers 2

IdentifierTypeStateIssuer
200179840MedicaidIN
64333115MedicaidKY

Medicare participation

Medicare enrollment files
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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131101000602 CA Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 5991873366 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
202409LAMDRegistered Nurse
A52709CAMDPediatric Emergency Medicine (Emergency Medicine) Physician
33113KYMDPediatric Emergency Medicine (Pediatrics) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Medicine Specialists of Orange County CurrentSince Aug 1, 2013 Accepting new patients
Administrators of the Tulane Educational Fund Past Accepting new patients

Locations

1100 W Stewart Dr
Orange, CA 92868
Phone (714) 532-8620

1201 W La Veta Ave
Orange, CA 92868
Phone (714) 509-8481

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386201600000",
    "number": "1942285507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 W LA VETA AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684203",
            "telephone_number": "502-541-2637",
            "fax_number": "949-748-6664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 W LA VETA AVE",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928684203",
            "telephone_number": "502-541-2637",
            "fax_number": "949-748-6664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALCID",
        "first_name": "CARLA MARIA",
        "middle_name": "PEREDO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-07",
        "last_updated": "2013-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "33113",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "KY",
            "license": "33113",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "LA",
            "license": "202409",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "LA",
            "license": "202409",
            "primary": false
        },
        {
            "code": "207PP0204X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Pediatric Emergency Medicine",
            "state": "CA",
            "license": "A52709",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200179840",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64333115",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

Verify at the official NPI Registry.