NPIMap

Organization Active NPI

Southern California Gastroenterology Anesthesia Specia

  • Certified Registered Nurse Anesthetist
  • San Diego, CA
National Provider Identifier
1073997359
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
SOUTHERN CALIFORNIA GASTROENTEROLOGY ANESTHESIA SPECIA
Practice address
286 Euclid Ave
Suite #109
San Diego, CA 92114-3610
Phone
(619) 266-1653
NPI assigned
Jul 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Authorized official

Name
John G Keenan, CRNANPI 1730157843
Title
President
Phone
(619) 857-8764

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
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

286 Euclid Ave
Suite #109
San Diego, CA 92114-3610

Mailing address

286 Euclid Ave Ste 110
San Diego, CA 92114-3611
Phone (310) 792-3914

Other names 1

  • SOUTHERN CALIFORNIA GASTROENTEROLOGY ANESTHESIA SPECIALISTS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150917001780 CA Part B Supplier - Clinic/Group Practice 1153638572 Receives reassigned benefits from 8 practitioners
Practice locations: Chula Vista, CA; El Cajon, CA; San Diego, CA

National Provider Directory

National Provider Directory

Locations

681 Third Ave
#B
Chula Vista, CA 91910
Phone (619) 425-2150

286 Euclid Ave
Ste 115
San Diego, CA 92114

286 Euclid Ave
Ste 110
San Diego, CA 92114

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1437004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1073997359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "286 EUCLID AVE STE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921143611",
            "telephone_number": "310-792-3914",
            "fax_number": "855-898-4055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 EUCLID AVE",
            "address_2": "SUITE #109",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921143610",
            "telephone_number": "619-266-1653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA GASTROENTEROLOGY ANESTHESIA SPECIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-16",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "KEENAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-857-8764",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN CALIFORNIA GASTROENTEROLOGY ANESTHESIA SPECIALISTS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.