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1073590105 NPI number — PRIMARY CARE ASSOCIATES MEDICAL GROUP, INC

NPI Number: 1073590105
Health Care Provider/Practitioner: PRIMARY CARE ASSOCIATES MEDICAL GROUP, INC

Information about “1073590105” NPI (PRIMARY CARE ASSOCIATES MEDICAL GROUP, INC) exists in 1073590105 in HTML format HTML  |  1073590105 in plain Text format TXT  |  1073590105 in PDF (Portable Document Format) PDF  |  1073590105 in an XML format XML  formats.

NPI Number : 1073590105 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073590105",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "PRIMARY CARE ASSOCIATES MEDICAL GROUP, INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": "6",
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3998 VISTA WAY",
    "SecondLineMailingAddress": "SUITE B",
    "MailingAddressCityName": "OCEANSIDE",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "92056-4500",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "760-724-5173",
    "MailingAddressFaxNumber": "760-724-5265",
    "FirstLinePracticeLocationAddress": "3998 VISTA WAY",
    "SecondLinePracticeLocationAddress": "SUITE B",
    "PracticeLocationAddressCityName": "OCEANSIDE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "92056-4500",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "760-724-5173",
    "PracticeLocationAddressFaxNumber": "760-724-5265",
    "EnumerationDate": "12/29/2005",
    "LastUpdateDate": "07/29/2008",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BRODY",
    "AuthorizedOfficialFirstName": "JEANNETTE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "BILLING MANAGER",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "760-724-1033",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207X00000X",
          "TaxonomyName": "Orthopaedic Surgery Physician",
          "LicenseNumber": "A47884",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA17120",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207XS0117X",
          "TaxonomyName": "Orthopaedic Surgery of the Spine Physician",
          "LicenseNumber": "A70831",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207XX0005X",
          "TaxonomyName": "Sports Medicine (Orthopaedic Surgery) Physician",
          "LicenseNumber": "A68137",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "213ES0103X",
          "TaxonomyName": "Foot & Ankle Surgery Podiatrist",
          "LicenseNumber": "E4564",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207X00000X",
          "TaxonomyName": "Orthopaedic Surgery Physician",
          "LicenseNumber": "A70831",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
        }
      ]
    }
  }
}
                
            

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