South County Urgent Care Medical Corporation

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

FNP30274 Issued in CA

Legal business name

SOUTH COUNTY URGENT CARE MEDICAL CORPORATION

Practice address

1300 Avenida Vista Hermosa
#100
San Clemente, CA 92673-6315

Phone

(949) 218-8050

Fax

(949) 218-8051

NPI assigned

May 18, 2007

Organization subpart

No

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

Authorized official

Name

Dr. John Gentile, M.D.NPI 1225171531

Title

Ceo

Phone

(949) 218-8050

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 5

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

• John Frederick Gentile, MD

  • Family Medicine Physician
  • San Clemente, CA
  • NPI 1225171531
  Medicare reassignment Care Compare group NPD Authorized official
• Mark F Burger, M.D.

  • General Practice Physician
  • Encinitas, CA
  • NPI 1578762712
  Medicare reassignment Care Compare group NPD
• Eva Marie Gentile, MD

  • Family Medicine Physician
  • San Clemente, CA
  • NPI 1811030117
  Medicare reassignment Care Compare group NPD
• Jeremy Paul Lamotte, MD

  • Family Medicine Physician
  • San Clemente, CA
  • NPI 1275504409
  Medicare reassignment NPD
• Ronald K. McGee, MD

  • Family Medicine Physician
  • San Clemente, CA
  • NPI 1891812350
  Medicare reassignment NPD

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522022400000",
    "number": "1083822639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 AVENIDA VISTA HERMOSA",
            "address_2": "#100",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736315",
            "telephone_number": "949-218-8050",
            "fax_number": "949-218-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 AVENIDA VISTA HERMOSA",
            "address_2": "#100",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736315",
            "telephone_number": "949-218-8050",
            "fax_number": "949-218-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY URGENT CARE MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2018-03-26",
        "status": "A",
        "authorized_official_last_name": "GENTILE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-218-8050",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "FNP30274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ05603Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sobriety Support Solutions
• Socal Detox, LLC
• Victoria Joy Soneff
• Krista Sornborger, DPT
• South County Addiction Treatment Services, Inc.
• South Oc Wellness
• South Orange County Outpatient Surgical Center Inc
• Katelyn Reno South
• Daniel A Souza, PT
• Terri A. Souza, PT

• Emergency Medicine Physician in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.