NPIMap

Organization Active NPI

Pediatric Surgical Associates Inc a Medical Corporation

  • Specialist
  • Orange, CA
National Provider Identifier
1073703245
Registry record updated Mar 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PEDIATRIC SURGICAL ASSOCIATES INC A MEDICAL CORPORATION
Practice address
396 S Main St Ste 200
Orange, CA 92868-3845
Phone
(714) 361-4480
Fax
(714) 361-4490
NPI assigned
Jul 25, 2007
Last updated
Mar 19, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2020

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

Authorized official

Name
Vinh Lam, MDNPI 1336119122
Title
Vice President
Phone
(714) 361-4480

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

396 S Main St Ste 200
Orange, CA 92868-3845

Mailing address

396 S Main St Ste 200
Orange, CA 92868-3845
Phone (714) 361-4480

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080521000932 CA Part B Supplier - Clinic/Group Practice 1153490701 Receives reassigned benefits from 1 practitioner
Practice locations: Orange, CA

National Provider Directory

National Provider Directory

Locations

396 S Main St
Ste 200
Orange, CA 92868
Phone (714) 361-4480

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1185321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584576000000",
    "number": "1073703245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "396 S MAIN ST STE 200",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683845",
            "telephone_number": "714-361-4480",
            "fax_number": "714-361-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "396 S MAIN ST STE 200",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928683845",
            "telephone_number": "714-361-4480",
            "fax_number": "714-361-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SURGICAL ASSOCIATES INC A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-25",
        "last_updated": "2020-03-19",
        "certification_date": "2020-03-19",
        "status": "A",
        "authorized_official_last_name": "LAM",
        "authorized_official_first_name": "VINH",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "714-361-4480",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2020; 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.