NPIMap

Organization Active NPI

South Coast Eye Care Centers a Comp Ophthalmology Medical GRP Inc.

  • Ophthalmology Physician
  • Laguna Hills, CA
National Provider Identifier
1063459725
Registry record updated Mar 15, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
G36573 Issued in CA
Legal business name
SOUTH COAST EYE CARE CENTERS A COMP OPHTHALMOLOGY MEDICAL GRP INC.
Practice address
23961 Calle de la Magdalena
Ste. 302
Laguna Hills, CA 92653-3616
Phone
(949) 588-2020
Fax
(949) 588-0336
NPI assigned
Jun 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2010

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

Authorized official

Name
Dr. Andrew Henrick, M.D.NPI 1700870821
Title
President
Phone
(949) 588-2020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X G36573 CA Primary
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X G73434 CA
Ophthalmology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207W00000X A77935 CA

Addresses

Primary practice location

23961 Calle de la Magdalena
Ste. 302
Laguna Hills, CA 92653-3616

Mailing address

23961 Calle de la Magdalena
Ste. 302
Laguna Hills, CA 92653-3616
Phone (949) 588-2020

Other identifiers 1

IdentifierTypeStateIssuer
GR0102520MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050806000096 CA Part B Supplier - Clinic/Group Practice 0547299901 Receives reassigned benefits from 10 practitioners
Practice locations: Laguna Hills, CA; Laguna Beach, CA

National Provider Directory

National Provider Directory

Locations

24022 Calle de la Plata
Ste 305
Laguna Hills, CA 92653
Phone (949) 588-2020

23961 Calle de la Magdalena
Ste 302
Laguna Hills, CA 92653
Phone (949) 588-2020

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268611200000",
    "number": "1063459725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23961 CALLE DE LA MAGDALENA",
            "address_2": "STE. 302",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533616",
            "telephone_number": "949-588-2020",
            "fax_number": "949-588-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23961 CALLE DE LA MAGDALENA",
            "address_2": "STE. 302",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926533616",
            "telephone_number": "949-588-2020",
            "fax_number": "949-588-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COAST EYE CARE CENTERS A COMP OPHTHALMOLOGY MEDICAL GRP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2010-03-15",
        "status": "A",
        "authorized_official_last_name": "HENRICK",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-588-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G36573",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "G73434",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "CA",
            "license": "A77935",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0102520",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2010; 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.