NPIMap

Organization Active NPI

Pacific Surgical Specialists Medical Group, Inc

  • Specialist
  • La Jolla, CA
National Provider Identifier
1083885107
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G65602 Issued in CA
Legal business name
PACIFIC SURGICAL SPECIALISTS MEDICAL GROUP, INC
Practice address
9850 Genesee Ave
510
La Jolla, CA 92037-1224
Phone
(858) 623-2345
Fax
(858) 623-2343
NPI assigned
Mar 17, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

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

Authorized official

Name
Dr. Mary K Wilde, MDNPI 1508901810
Title
President
Phone
(858) 623-2345

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X G65602 CA Primary

Addresses

Primary practice location

9850 Genesee Ave
510
La Jolla, CA 92037-1224

Mailing address

9850 Genesee Ave
510
La Jolla, CA 92037-1224
Phone (858) 623-2345

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1205712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1083885107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE",
            "address_2": "510",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371224",
            "telephone_number": "858-623-2345",
            "fax_number": "858-623-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE",
            "address_2": "510",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371224",
            "telephone_number": "858-623-2345",
            "fax_number": "858-623-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC SURGICAL SPECIALISTS MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-17",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "WILDE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-623-2345",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G65602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.