CLINICA WESTERN
NPI 1215100417
Clinic/Center - Primary Care in Los Angeles, CA
About Clinica Western NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CLINICA WESTERN (NPI 1215100417) is a healthcare organization registered as a primary care in Los Angeles, California and active in the NPI registry since April 2008. The organization holds a CLIA Waiver certificate valid through July 9, 2027 and lists Dante Atienza Banta, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 2
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Clinica Western is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Clinica Western, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D0903012
Clinica Western Family Medical Clinic · Los Angeles, CAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Dante A. Banta, M.D., Inc.'s NPI number?
The NPI number for Dante A. Banta, M.D., Inc. is 1215100417. It was assigned to this organization in the NPPES registry on April 8, 2008. The provider is doing business as Clinica Western.
Where is Dante A. Banta, M.D., Inc. located?
Dante A. Banta, M.D., Inc. is located at 875 N Western Ave, Los Angeles, CA 90029. The listed phone number is (323) 461-0777.
What is Dante A. Banta, M.D., Inc.'s specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Dante A. Banta, M.D., Inc. enrolled in Medicare?
Yes. Dante A. Banta, M.D., Inc. is registered in the Medicare PECOS enrollment system.
When is Dante A. Banta, M.D., Inc.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (California, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Dante A. Banta, M.D., Inc.?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Dante A. Banta, M.D., Inc., in Family Practice and General Practice. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Dante A. Banta, M.D., Inc. hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D0903012) is associated with this NPI, valid through July 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Dante A. Banta, M.D., Inc. was last updated on August 2, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Clinica Western · NPI 1215100417
Primary Care organization in Los Angeles, California. Organization record, active in the CMS NPPES registry since April 8, 2008.
## Identity
- **NPI:** 1215100417 (Entity type: Organization)
- **Enumerated:** April 8, 2008
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Legal business name:** Dante A. Banta, M.d., Inc.
- **Organization subpart:** No
- **Authorized official:** Dante Banta, PRESIDENT
## Practice location
- **Address:** 875 N WESTERN AVE, Los Angeles, CA 90029-3759
- **Phone:** (323) 461-0777 · **Fax:** (323) 461-8035
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, California, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 2 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), General Practice (1); 2 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 2, 2011
- **Other identifiers:** Medicare PIN A44079 (CA); Medicaid 00A440791 (CA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1215100417) · Data from the CMS NPPES public registry.