NPIMap

Organization Active NPI

Southern California Permanente Medical Group

Doing business as Target Clinic Medical Associates of Southern California

  • Health Maintenance Organization
  • San Diego, CA
National Provider Identifier
1023425972
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
Doing business as
Target Clinic Medical Associates of Southern California
Practice address
1288 Camino del Rio N
San Diego, CA 92108-1511
Phone
(877) 608-0044
NPI assigned
Jul 11, 2014
Last updated
Nov 2, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Authorized official

Name
Dr. Ramin Davidoff, M.D.
Title
Executive Medical Director
Phone
(877) 608-0044

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X NU Primary

Addresses

Primary practice location

1288 Camino del Rio N
San Diego, CA 92108-1511

Mailing address

393 E Walnut St
Provider Enrollment, 3Rd Floor
Pasadena, CA 91188-0001
Phone (877) 608-0044

Other names 1

  • Target Clinic Medical Associates of Southern California Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031110000678 CA Part B Supplier - Clinic/Group Practice 6002729175 Receives reassigned benefits from 14,591 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20040126000823 CA Part B Supplier - Clinic/Group Practice 6002729175 Receives reassigned benefits from 5,496 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 28

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 28

National Provider Directory

National Provider Directory

Locations

9353 Imperial Hwy
Downey, CA 90242
Phone (562) 657-4110

10990 San Diego Mission Rd
San Diego, CA 92108
Phone (619) 528-1245

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

4650 Palm Ave
San Diego, CA 92154
Phone (619) 662-5226

Practitioners & affiliated clinicians

Practitioners 515

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 515

NPI Registry JSON

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

{
    "created_epoch": "1405036800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1023425972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "393 E WALNUT ST",
            "address_2": "PROVIDER ENROLLMENT, 3RD FLOOR",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911880001",
            "telephone_number": "877-608-0044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1288 CAMINO DEL RIO N",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081511",
            "telephone_number": "877-608-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-11",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "DAVIDOFF",
        "authorized_official_first_name": "RAMIN",
        "authorized_official_title_or_position": "EXECUTIVE MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "877-608-0044",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1288 Camino Del Rio N",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921081511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Target Clinic Medical Associates of Southern California",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Target Clinic Medical Associates of Southern California",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.