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PAVILION NEUROLOGY MEDICAL GROUP INC.
NPI 1972636009
Specialist in Orange, CA

Active since March 14, 2007
1140 W LA VETA AVE STE 730, ORANGE, CA 92868(714) 541-6800(714) 541-1591 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Pavilion Neurology Medical Group Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PAVILION NEUROLOGY MEDICAL GROUP INC. (NPI 1972636009) is a healthcare organization registered as a specialist in Orange, California and active in the NPI registry since March 2007. The organization lists Elsa Carmona, Manager, as its authorized official.

NPPES Registry Identity

NPI1972636009
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NamePAVILION NEUROLOGY MEDICAL GROUP INC.
Location Address1140 W LA VETA AVE STE 730Orange, CA 92868-4229
Mailing Address1140 W La Veta Ave Ste 730Orange, CA 92868-4229 · (714) 541-6800 · Fax (714) 541-1591
Phone(714) 541-6800
Fax(714) 541-1591
Organization SubpartNo
Authorized OfficialElsa CarmonaManager · (714) 541-6800
Enumeration DateMarch 14, 2007
Last NPPES UpdateJuly 21, 2022
✔ NPI 1972636009 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
1140 W LA VETA AVE STE 730, Orange, CA 92868
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Pavilion Neurology Medical Group Inc. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

6

Medicare enrollment records show 6 clinicians reassign Medicare billing to Pavilion Neurology Medical Group Inc., which bills Medicare for the services they deliver. Of these, 3 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Karly Borunda, FNP
Nurse Practitioner
NPI 1174179725
1140 W LA VETA AVE STE 730
Orange, CA 92868
(714) 541-6800
✔ PECOS✔ Accepts MedicareSame address
Amir Shokrae, M.D.
Neurology
NPI 1306934112
1140 W LA VETA AVE STE 730
Orange, CA 92868
(714) 541-6800
✔ PECOS✔ Accepts MedicareSame address
Mayank Pathak, M.D.
Neurology
NPI 1114959475
1140 W LA VETA AVE SUITE 730
Orange, CA 92868
(714) 541-6800
✔ PECOS✔ Accepts MedicareSame address
Nancy Kamimura, FNP
Nurse Practitioner
NPI 1063850212
1809 W CHAPMAN AVE
Orange, CA 92868
(800) 881-5101
✔ PECOS✔ Accepts Medicare0.7 mi
Amr Al Hariri, M.D.
Neurology
NPI 1497862254
1050 LAS TABLAS RD SUITE 10
Templeton, CA 93465
(805) 434-2482
✔ PECOS✔ Accepts Medicare203 mi
Neelantha De Silva, M.D.
Neurology
NPI 1407944002
11215 METRO PKWY STE 100
Fort Myers, FL 33966
(239) 208-2206
✔ PECOS✔ Accepts Medicare2,200 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently 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 Pavilion Neurology Medical Group Inc.'s NPI number?

The NPI number for Pavilion Neurology Medical Group Inc. is 1972636009. It was assigned to this organization in the NPPES registry on March 14, 2007.

Where is Pavilion Neurology Medical Group Inc. located?

Pavilion Neurology Medical Group Inc. is located at 1140 W La Veta Ave Ste 730, Orange, CA 92868. The listed phone number is (714) 541-6800.

What is Pavilion Neurology Medical Group Inc.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Pavilion Neurology Medical Group Inc. enrolled in Medicare?

Yes. Pavilion Neurology Medical Group Inc. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Pavilion Neurology Medical Group Inc.?

According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 2 Medicare specialties reassign their Medicare billing to Pavilion Neurology Medical Group Inc.. 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. The largest specialties are Neurology (4) and Nurse Practitioner (2). Of these, 3 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Pavilion Neurology Medical Group Inc. was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.