Individual provider Active NPI

Maggie Frye

  • Adult Health Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1063133692
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
95028580 Issued in CA
Practice address
4077 5TH Ave
San Diego, CA 92103-2105
Phone
(196) 868-3800
NPI assigned
Sep 12, 2022
Last updated
Feb 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 95028580 CA Primary

Addresses

Primary practice location

4077 5TH Ave
San Diego, CA 92103-2105

Mailing address

995 Gateway Center Way
San Diego, CA 92102-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241211002188 CA Practitioner - Nurse Practitioner 4183150360 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Somagen Healthcare IncGroup PAC ID 1557530151, 53 clinicians

Practice addresses (Care Compare)

5671 Balboa Ave
San Diego, CA 92111-2705
Phone (858) 800-2880

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
95028580CAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Somagen Healthcare Inc CurrentSince Dec 9, 2024 Accepting new patients
Somagen Healthcare Inc Current Accepting new patients
Somagen Healthcare Inc CurrentSince Dec 9, 2024 Accepting new patients
Somagen Healthcare Inc Past Accepting new patients
Somagen Healthcare Inc Past Accepting new patients
Somagen Healthcare Inc Past Accepting new patients
Somagen Healthcare Inc Past Accepting new patients

Locations

750 Otay Lakes Rd
Chula Vista, CA 91910
Phone (619) 259-9462

760 Otay Lakes Rd
Chula Vista, CA 91910
Phone (619) 821-2300

1740 Rosecrans St
San Diego, CA 92106
Phone (619) 790-7800

5671 Balboa Ave
San Diego, CA 92111
Phone (855) 362-9773

8260 Mira Mesa Blvd
Ste A
San Diego, CA 92126
Phone (855) 362-9773

8590 Rio San Diego Dr
Ste 111
San Diego, CA 92108
Phone (619) 736-4600

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1063133692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 5TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "196-868-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRYE",
        "first_name": "MAGGIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-12",
        "last_updated": "2024-02-01",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "95028580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.