Marta Lucia Miguelena, MD
Family Practice · San Jose
- Medicare standing
- Clear
- Enrolled, allowed to bill and order, not excluded
- Plans that list them
- 7
- 3 carriers
- Offices
- 2
Offices
2 locations · University Healthcare Alliance · Indian Health Center of Santa Clara Valley
Hospitals listed: Santa Clara Valley Medical Center · Stanford Health Care. That is not proof they admit you there this week.
Plans that list them
7 plans · 3 carriers
A missing listing does not mean out of network. Directories change, and a listing does not cover every office. Call Dr. Miguelena’s office at (408) 995-5453 to confirm they take your plan. Ask about the office you use, its medical group, referrals and appointments.
7 of 7 plans
| Anthem Full Dual Advantage Aligned (HMO D-SNP) | Anthem Blue Cross | Listed | Oct 3, 2026 |
| Anthem Medicare Advantage (HMO-POS) | Anthem Blue Cross | Listed | Oct 3, 2026 |
| SCAN Balance (HMO C-SNP) | SCAN Health Plan | Listed | Oct 3, 2026 |
| SCAN Classic (HMO) | SCAN Health Plan | Listed | Oct 3, 2026 |
| SCAN MyChoice (HMO) | SCAN Health Plan | Listed | Oct 3, 2026 |
| SCAN Strive (HMO C-SNP) | SCAN Health Plan | Listed | Oct 3, 2026 |
| DualConnect (HMO D-SNP) | Santa Clara Family Health Plan | Listed | Sep 1, 2026 |
Hospitals they work in
2 hospitals
These rate the hospital, not this clinician. Most measures at most hospitals are no different from the national rate.
- Santa Clara Valley Medical CenterSan Jose, CAAcute Care Hospital · Government - Local · Has an emergency department · Birthing-friendlyPart of Santa Clara Valley Health and Hospital System, which runs 3 hospitalsPatients rate it 3 of 5 · 70% would definitely recommend itOverall rating: 2 of 5 starsWorse than the national rate — SSI - Colon Surgery: 2.572, Oct 2024 – Sep 2025Better than the national rate — Central Line Associated Bloodstream Infection (ICU + select Wards): 0.563, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.256, Oct 2024 – Sep 2025Better than the national rate — MRSA Bacteremia: 0.369, Oct 2024 – Sep 2025
- Stanford Health CareStanford, CAAcute Care Hospital · Voluntary non-profit - Private · Has an emergency departmentPart of Stanford Health Care, which runs 3 hospitalsHome of Stanford Cancer Institute, a National Cancer Institute designated comprehensive cancer centrePatients rate it 4 of 5 · 83% would definitely recommend itOverall rating: 5 of 5 starsWorse than the national rate — Perioperative pulmonary embolism or deep vein thrombosis rate: 5.31 (4.24 to 6.37) · 8,661 cases, Jul 2022 – Jun 2024Worse than the national rate — Rate of inpatient admissions for patients receiving outpatient chemotherapy: 14.1 (12.7 to 15.7) · 2,191 cases, Jan 2024 – Dec 2024Better than the national rate — Postoperative respiratory failure rate: 4.08 (1.95 to 6.21) · 5,296 cases, Jul 2022 – Jun 2024Better than the national rate — Catheter Associated Urinary Tract Infections (ICU + select Wards): 0.317, Oct 2024 – Sep 2025Better than the national rate — Clostridium Difficile (C.Diff): 0.446, Oct 2024 – Sep 2025Better than the national rate — SSI - Colon Surgery: 0.241, Oct 2024 – Sep 2025Better than the national rate — Ratio of unplanned hospital visits after hospital outpatient surgery: 0.7 (0.6 to 0.9) · 3,348 cases, Jan 2024 – Dec 2024
See every measure and the patient survey for Santa Clara Valley Medical Center
Behind the star rating — Deaths: 2 better, 6 the same, 0 worse of 8 measures. Safety: 2 better, 5 the same, 1 worse of 8 measures. Readmissions: 0 better, 10 the same, 1 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.
| SSI - Colon SurgeryInfections | 2.572 | Worse | Oct 2024 – Sep 2025 |
| Central Line Associated Bloodstream Infection (ICU + select Wards)Infections | 0.563 | Better | Oct 2024 – Sep 2025 |
| Clostridium Difficile (C.Diff)Infections | 0.256 | Better | Oct 2024 – Sep 2025 |
| MRSA BacteremiaInfections | 0.369 | Better | Oct 2024 – Sep 2025 |
| Abdominopelvic accidental puncture or laceration rateComplications and deaths | 1.25 (0.3 to 2.2) · 1,535 cases | No different | Jul 2022 – Jun 2024 |
| CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths | 1.07 (0.76 to 1.38) | No different | Jul 2022 – Jun 2024 |
| Death rate among surgical inpatients with serious treatable complicationsComplications and deaths | 214.59 (167.38 to 261.8) · 108 cases | No different | Jul 2022 – Jun 2024 |
| Death rate for CABG surgery patientsComplications and deaths | 2.8 · 41 cases | None | Jul 2022 – Jun 2025 |
| Death rate for COPD patientsComplications and deaths | 6 · 141 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart attack patientsComplications and deaths | 10.2 · 124 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart failure patientsComplications and deaths | 8.3 · 501 cases | None | Jul 2022 – Jun 2025 |
| Death rate for pneumonia patientsComplications and deaths | 14.9 · 653 cases | None | Jul 2022 – Jun 2025 |
| Death rate for stroke patientsComplications and deaths | 10.1 · 348 cases | None | Jul 2023 – Jun 2025 |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths | 3 · 4,502 cases | None | Jul 2024 – Jun 2025 |
| Iatrogenic pneumothorax rateComplications and deaths | 0.24 (0.04 to 0.43) · 9,014 cases | No different | Jul 2022 – Jun 2024 |
| In-hospital fall-associated fracture rateComplications and deaths | 0.34 (0.15 to 0.52) · 9,216 cases | No different | Jul 2022 – Jun 2024 |
| Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths | 4.54 (2.51 to 6.58) · 1,421 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative acute kidney injury requiring dialysis rateComplications and deaths | 1.54 (0 to 3.2) · 288 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative hemorrhage or hematoma rateComplications and deaths | 2.11 (0.66 to 3.56) · 1,446 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative respiratory failure rateComplications and deaths | 11.61 (4.09 to 19.14) · 294 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative sepsis rateComplications and deaths | 7.29 (3.39 to 11.2) · 299 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative wound dehiscence rateComplications and deaths | 1.9 (0.45 to 3.36) · 333 cases | No different | Jul 2022 – Jun 2024 |
| Pressure ulcer rateComplications and deaths | 0.23 (0 to 0.78) · 7,538 cases | No different | Jul 2022 – Jun 2024 |
| Rate of complications for hip/knee replacement patientsComplications and deaths | 5.4 · 94 cases | None | Apr 2023 – Mar 2025 |
| Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections | 0.735 | No different | Oct 2024 – Sep 2025 |
| SSI - Abdominal HysterectomyInfections | 2.573 | No different | Oct 2024 – Sep 2025 |
| Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits | 14.6 · 185 cases | None | Jul 2023 – Jun 2025 |
| Heart failure (HF) 30-Day Readmission RateUnplanned return visits | 22.1 · 951 cases | None | Jul 2023 – Jun 2025 |
| Hospital return days for heart attack patientsUnplanned return visits | 56.3 · 128 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for heart failure patientsUnplanned return visits | 6.4 · 644 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for pneumonia patientsUnplanned return visits | 1.3 · 699 cases | None | Jul 2022 – Jun 2025 |
| Pneumonia (PN) 30-Day Readmission RateUnplanned return visits | 16.3 · 921 cases | None | Jul 2023 – Jun 2025 |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits | 5.7 (3.9 to 8.1) · 226 cases | No different | Jan 2024 – Dec 2024 |
| Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits | 12.6 (9.4 to 16.5) · 226 cases | No different | Jan 2024 – Dec 2024 |
| Rate of readmission after hip/knee replacementUnplanned return visits | 5.4 · 94 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for CABGUnplanned return visits | 11.4 · 54 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits | 20.3 · 242 cases | None | Jul 2023 – Jun 2025 |
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits | 13.2 (9.9 to 17.4) · 702 cases | No different | Jan 2022 – Dec 2024 |
| Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits | 1 (0.7 to 1.4) · 195 cases | No different | Jan 2024 – Dec 2024 |
What patients said (4,032 patients answered, 29% of those asked)
| Cleanliness | 3 |
| Nurse communication | 3 |
| Doctor communication | 3 |
| Communication about medicines | 3 |
| Discharge information | 2 |
| Overall hospital rating | 3 |
| Quietness | 2 |
| Recommend hospital | 4 |
| Room was "always" clean | 70% |
| Nurses "always" communicated well | 73% |
| Doctors "always" communicated well | 76% |
| Staff "always" explained | 57% |
| Yes, staff "did" give patients this information | 82% |
| Yes, staff "did" give patients information about help after discharge | 82% |
| Doctors "always" explained things so they could understand | 71% |
| Doctors "always" listened carefully | 74% |
| Doctors "always" treated them with courtesy and respect | 82% |
| Patients who gave a rating of "9" or "10" (high) | 67% |
| Staff "always" explained new medications | 71% |
| Nurses "always" explained things so they could understand | 71% |
| Nurses "always" listened carefully | 69% |
| Nurses "always" treated them with courtesy and respect | 80% |
| "Always" quiet at night | 43% |
| "YES", patients would definitely recommend the hospital | 70% |
| Staff "always" explained possible side effects | 44% |
| Yes, staff "did" give patients information about possible symptoms | 83% |
See every measure and the patient survey for Stanford Health Care
Behind the star rating — Deaths: 5 better, 3 the same, 0 worse of 8 measures. Safety: 3 better, 5 the same, 0 worse of 8 measures. Readmissions: 2 better, 5 the same, 4 worse of 11 measures. The star rating is worked out from an earlier period than the measures below, so the two can disagree.
| Perioperative pulmonary embolism or deep vein thrombosis rateComplications and deaths | 5.31 (4.24 to 6.37) · 8,661 cases | Worse | Jul 2022 – Jun 2024 |
| Rate of inpatient admissions for patients receiving outpatient chemotherapyUnplanned return visits | 14.1 (12.7 to 15.7) · 2,191 cases | Worse | Jan 2024 – Dec 2024 |
| Postoperative respiratory failure rateComplications and deaths | 4.08 (1.95 to 6.21) · 5,296 cases | Better | Jul 2022 – Jun 2024 |
| Catheter Associated Urinary Tract Infections (ICU + select Wards)Infections | 0.317 | Better | Oct 2024 – Sep 2025 |
| Clostridium Difficile (C.Diff)Infections | 0.446 | Better | Oct 2024 – Sep 2025 |
| SSI - Colon SurgeryInfections | 0.241 | Better | Oct 2024 – Sep 2025 |
| Ratio of unplanned hospital visits after hospital outpatient surgeryUnplanned return visits | 0.7 (0.6 to 0.9) · 3,348 cases | Better | Jan 2024 – Dec 2024 |
| Abdominopelvic accidental puncture or laceration rateComplications and deaths | 1.06 (0.45 to 1.67) · 5,374 cases | No different | Jul 2022 – Jun 2024 |
| CMS Medicare PSI 90: Patient safety and adverse events compositeComplications and deaths | 0.86 (0.72 to 1) | No different | Jul 2022 – Jun 2024 |
| Death rate among surgical inpatients with serious treatable complicationsComplications and deaths | 166.09 (137.88 to 194.3) · 470 cases | No different | Jul 2022 – Jun 2024 |
| Death rate for CABG surgery patientsComplications and deaths | 1.1 · 192 cases | None | Jul 2022 – Jun 2025 |
| Death rate for COPD patientsComplications and deaths | 6.4 · 146 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart attack patientsComplications and deaths | 9.7 · 253 cases | None | Jul 2022 – Jun 2025 |
| Death rate for heart failure patientsComplications and deaths | 6.3 · 880 cases | None | Jul 2022 – Jun 2025 |
| Death rate for pneumonia patientsComplications and deaths | 10.3 · 935 cases | None | Jul 2022 – Jun 2025 |
| Death rate for stroke patientsComplications and deaths | 8.7 · 501 cases | None | Jul 2023 – Jun 2025 |
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality RateComplications and deaths | 2.1 · 7,730 cases | None | Jul 2024 – Jun 2025 |
| Iatrogenic pneumothorax rateComplications and deaths | 0.13 (0 to 0.27) · 20,799 cases | No different | Jul 2022 – Jun 2024 |
| In-hospital fall-associated fracture rateComplications and deaths | 0.28 (0.14 to 0.43) · 23,182 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative acute kidney injury requiring dialysis rateComplications and deaths | 0.94 (0.2 to 1.68) · 5,694 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative hemorrhage or hematoma rateComplications and deaths | 2.36 (1.54 to 3.19) · 7,846 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative sepsis rateComplications and deaths | 5.2 (3.76 to 6.64) · 5,603 cases | No different | Jul 2022 – Jun 2024 |
| Postoperative wound dehiscence rateComplications and deaths | 1.38 (0.23 to 2.53) · 2,211 cases | No different | Jul 2022 – Jun 2024 |
| Pressure ulcer rateComplications and deaths | 0.52 (0.21 to 0.83) · 19,915 cases | No different | Jul 2022 – Jun 2024 |
| Rate of complications for hip/knee replacement patientsComplications and deaths | 3.6 · 416 cases | None | Apr 2023 – Mar 2025 |
| Central Line Associated Bloodstream Infection (ICU + select Wards)Infections | 0.869 | No different | Oct 2024 – Sep 2025 |
| MRSA BacteremiaInfections | 0.857 | No different | Oct 2024 – Sep 2025 |
| SSI - Abdominal HysterectomyInfections | 0.368 | No different | Oct 2024 – Sep 2025 |
| Acute Myocardial Infarction (AMI) 30-Day Readmission RateUnplanned return visits | 16.2 · 247 cases | None | Jul 2023 – Jun 2025 |
| Heart failure (HF) 30-Day Readmission RateUnplanned return visits | 20.5 · 1,021 cases | None | Jul 2023 – Jun 2025 |
| Hospital return days for heart attack patientsUnplanned return visits | 47.8 · 258 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for heart failure patientsUnplanned return visits | -1.6 · 990 cases | None | Jul 2022 – Jun 2025 |
| Hospital return days for pneumonia patientsUnplanned return visits | 20.8 · 976 cases | None | Jul 2022 – Jun 2025 |
| Pneumonia (PN) 30-Day Readmission RateUnplanned return visits | 16.5 · 959 cases | None | Jul 2023 – Jun 2025 |
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapyUnplanned return visits | 5.2 (4.4 to 6.2) · 2,191 cases | No different | Jan 2024 – Dec 2024 |
| Rate of readmission after hip/knee replacementUnplanned return visits | 5.1 · 425 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for CABGUnplanned return visits | 9.6 · 158 cases | None | Jul 2023 – Jun 2025 |
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patientsUnplanned return visits | 19.6 · 183 cases | None | Jul 2023 – Jun 2025 |
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)Unplanned return visits | 12.7 (10.4 to 15.4) · 4,578 cases | No different | Jan 2022 – Dec 2024 |
What patients said (6,810 patients answered, 25% of those asked)
| Cleanliness | 4 |
| Nurse communication | 4 |
| Doctor communication | 4 |
| Communication about medicines | 3 |
| Discharge information | 4 |
| Overall hospital rating | 4 |
| Quietness | 2 |
| Recommend hospital | 5 |
| Room was "always" clean | 75% |
| Nurses "always" communicated well | 82% |
| Doctors "always" communicated well | 81% |
| Staff "always" explained | 63% |
| Yes, staff "did" give patients this information | 89% |
| Yes, staff "did" give patients information about help after discharge | 89% |
| Doctors "always" explained things so they could understand | 76% |
| Doctors "always" listened carefully | 80% |
| Doctors "always" treated them with courtesy and respect | 87% |
| Patients who gave a rating of "9" or "10" (high) | 79% |
| Staff "always" explained new medications | 76% |
| Nurses "always" explained things so they could understand | 77% |
| Nurses "always" listened carefully | 79% |
| Nurses "always" treated them with courtesy and respect | 88% |
| "Always" quiet at night | 53% |
| "YES", patients would definitely recommend the hospital | 83% |
| Staff "always" explained possible side effects | 50% |
| Yes, staff "did" give patients information about possible symptoms | 90% |
Original Medicare doctor bills
$5,030
Medicare paid this office $5,030 for 20 people.
This is what Medicare paid the clinician — not Medicare Advantage, and not the pharmacy.
Procedures Medicare counted
| Skin biopsy | 1-10 | None |
Who their Medicare patients are
20 Original Medicare patients in 2024. Average age 76 · Health risk score 2.40. Sicker patients than 9 in 10 peers; the typical family practice clinician is at 1.13.
Conditions among them: High blood pressure 75%.
The office billed $20,562, Medicare allowed $6,313 and paid $5,030; for 60 services of 11 kinds.
Original Medicare patients only. A risk score of 1.0 is the average Medicare patient; higher means sicker. Any count under 11 is hidden.
Medicaid work
$2,255 in 2024
Medicaid paid $2,255 for 99 billed services this clinician did in 2024, up to 18 people in a month for one service.
Medicaid and CHIP claims where this clinician did the service, fee-for-service and managed care together. Any month with fewer than 11 patients is hidden, so small Medicaid practices undercount.
| SBSQ HOSPITAL IP/OBS CARE MOD MDM 35 MINUTES | 69 | $1,433 |
| 1ST HOSPITAL IP/OBS CARE MODERATE MDM 55 MINUTES | 15 | $506 |
| Hospital inpatient or observation discharge day management; 30 minutes or less on the date of the encounter | 15 | $316 |
| 2024 | 99 | 3 | 18 | $2,255 |
| 2023 | 44 | 1 | 17 | $10,620 |
| 2022 | 91 | 2 | 41 | $15,104 |
See the largest Medicaid services in earlier years
2023
| Clinic visit/encounter, all-inclusive | 44 | $10,620 |
2022
| Clinic visit/encounter, all-inclusive | 62 | $15,104 |
| Short return visit (20+ min) | 29 | $0 |
Drugs they prescribed that Part D paid
$55,019
Pharmacies billed $55,019 in 2024.
This is pharmacy cost, not the office bill, and not what patients paid.
327 generic and fewer than 11 brand-name prescriptions · $55,019 in drug cost · 12 antibiotic prescriptions to 11 people.
Part D prescriptions only. The opioid rate is opioid prescriptions as a share of all this clinician's Part D prescriptions; surgeons and pain specialists run higher than others, so it is shown against the same specialty.
| Jardiance | 20 | $16,585 | $829 |
| Albuterol Sulfate Hfa | 11 | $335 | $30 |
| Famotidine | 14 | $186 | $13 |
| Pravastatin | 12 | $144 | $12 |
| Metformin | 25 | $142 | $6 |
See all 9 drugs
| Jardiance | 20 | $16,585 | $829 |
| Albuterol Sulfate Hfa | 11 | $335 | $30 |
| Famotidine | 14 | $186 | $13 |
| Pravastatin | 12 | $144 | $12 |
| Metformin | 25 | $142 | $6 |
| Amlodipine Besylate | 26 | $102 | $4 |
| Atorvastatin | 17 | $99 | $6 |
| Losartan | 17 | $94 | $6 |
| Lisinopril | 15 | $90 | $6 |
Year by year
| 2024 | 416 | 104 | None | None | $55,019 |
| 2023 | 540 | 103 | None | 18% | $77,441 |
| 2022 | 198 | 49 | None | None | $21,072 |
Part D prescriptions only. A drug prescribed to fewer than 11 people in a year is hidden.
See the drugs prescribed each year
2023: 11 drugs
| Jardiance | 25 | $27,635 | $1,105 |
| Lidocaine | 15 | $1,409 | $94 |
| Atorvastatin | 29 | $1,079 | $37 |
| Amlodipine Besylate | 25 | $602 | $24 |
| Famotidine | 18 | $410 | $23 |
| Metformin | 26 | $376 | $14 |
| Lisinopril | 23 | $363 | $16 |
| Rosuvastatin | 16 | $342 | $21 |
| Losartan | 25 | $332 | $13 |
| Omeprazole | 20 | $218 | $11 |
| Clopidogrel | 11 | $206 | $19 |
2022: 3 drugs
| Metformin | 12 | $159 | $13 |
| Atorvastatin | 14 | $123 | $9 |
| Lisinopril | 12 | $111 | $9 |
Professional record
- NPI
- 1598344251
- Trained
- University of California, Davis School of Medicine, 2021
- Group
- University Healthcare Alliance · Indian Health Center of Santa Clara Valley
- Video visits
- Lists video visits
- Gender
- Female
More record details
- Sole proprietor
- No
- Taxonomy
- Family medicine (207Q00000X)
- Mailing address
- 455 Oconnor Dr Ste 250, San Jose, CA, 95128
- NPI first listed
- 2021-04-07
- NPI last updated
- 2025-06-05
- NPI record certified
- 2025-06-05
This is when the NPI record was last certified, not a medical board exam.
Extra NPI addresses: 1333 Meridian Ave, San Jose, CA, 95125 · 1642 E Capitol Expy, San Jose, CA, 95121 · 2039 Forest Ave, San Jose, CA, 95128