John H Clancy DO and Tara Leigh Clancy DO Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9614 Issued in CA

Legal business name

JOHN H CLANCY DO AND TARA LEIGH CLANCY DO MEDICAL CORPORATION

Practice address

2375 S Melrose Dr
Vista, CA 92081-8788

Phone

(760) 305-1900

Fax

(760) 305-1910

NPI assigned

May 12, 2014

Organization subpart

No

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

Authorized official

Name

Dr. John Harold Clancy, D.O.NPI 1962506238

Title

President

Phone

(760) 305-1900

Specialties & licenses 2

Addresses

Other names 1

• Clancy Medical Group Other name

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Clancy, DO

  • Internal Medicine Physician
  • Vista, CA
  • NPI 1962506238
  Medicare reassignment Care Compare group NPD Authorized official
• Tara Leigh Clancy, D.O.

  • Pediatrics Physician
  • Vista, CA
  • NPI 1588086003

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Shannon Baker, FNP

  • Family Nurse Practitioner
  • San Marcos, CA
  • NPI 1518191014
  Medicare reassignment NPD
• Anna Armstrong Graves, PA-C

  • Physician Assistant
  • Vista, CA
  • NPI 1689435430
  Medicare reassignment
• Lissande Mercedes Laverty, PA-C

  • Physician Assistant
  • Vista, CA
  • NPI 1285142125
  Medicare reassignment
• Rachel Moriah Watters, PA-C, MPH, MHA

  • Physician Assistant
  • San Diego, CA
  • NPI 1932813425
  Medicare reassignment

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1053722124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2375 S MELROSE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920818788",
            "telephone_number": "760-305-1900",
            "fax_number": "760-305-1910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2375 S MELROSE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920818788",
            "telephone_number": "760-305-1900",
            "fax_number": "760-305-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN H CLANCY DO AND TARA LEIGH CLANCY DO MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-12",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "CLANCY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-305-1900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "9614",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "9695",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clancy Medical Group",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Clancy Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• John N Dabbs III
• Angela Helena Johnson
• Ashley M Johnson, MSW
• Cindy Johnson

• Internal Medicine Physician in Vista, CA
• Providers in Vista, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.