NPIMap

Individual provider Active NPI

Neysan Pucks, MD

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1073142659
Registry record updated Apr 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A203912 Issued in CA
Practice address
2929 Health Center Dr
San Diego, CA 92123-2762
Phone
(858) 939-5241
Fax
(503) 413-6892
NPI assigned
Apr 6, 2020
Last updated
Apr 4, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD215330 OR
Internal Medicine Physician 207R00000X A203912 CA Primary

Addresses

Primary practice location

2929 Health Center Dr
San Diego, CA 92123-2762

Mailing address

2929 Health Center Dr
San Diego, CA 92123-2762
Phone (858) 939-5241

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230620000845 OR Practitioner - Internal Medicine 5395168348 Reassigns benefits to 3 organizations
I20260414001774 CA Practitioner - Internal Medicine 5395168348 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Legacy Clinics LLCGroup PAC ID 0244144004, 714 clinicians
Sharp Rees-Stealy Medical Group IncGroup PAC ID 8628972759, 872 clinicians

Practice addresses (Care Compare)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (503) 413-7711

1015 Nw22Nd Ave
Suite 34
Portland, OR 97210-3025
Phone (503) 413-6376

1130 NW 22ND Ave
Suite 220
Portland, OR 97210-2969
Phone (503) 413-8988

2801 N Gantenbein Ave
Portland, OR 97227-1623
Phone (503) 413-1122

2929 Health Ctr Dr
San Diego, CA 92123-2762
Phone (858) 499-2600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A203912CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Sep 18, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center Current Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jun 9, 2023 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center Current Accepting new patients
Legacy Clinics LLC Internal Medicine CurrentSince Sep 18, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Jun 9, 2023 Accepting new patients
Legacy Good Samaritan Hospital and Medical Center CurrentSince Jun 9, 2023 Accepting new patients
Legacy Emanuel Hospital & Health Center CurrentSince Jun 9, 2023 Accepting new patients

Locations

2800 N Vancouver Ave
Ste 230
Portland, OR 97227
Phone (503) 413-2901

1200 NW 23rd Ave
Portland, OR 97210
Phone (503) 413-7074

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

Organizations & group practices 9

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775260800000",
    "number": "1073142659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2929 HEALTH CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232762",
            "telephone_number": "858-939-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2929 HEALTH CENTER DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232762",
            "telephone_number": "858-939-5241",
            "fax_number": "503-413-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKS",
        "first_name": "NEYSAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-06",
        "last_updated": "2026-04-04",
        "certification_date": "2026-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OR",
            "license": "MD215330",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A203912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.