Organization Active NPI

Proton Doctors Professional Corporation

  • Radiation Oncology Physician
  • San Diego, CA
National Provider Identifier
1093240285
Registry record updated Aug 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
Legal business name
PROTON DOCTORS PROFESSIONAL CORPORATION
Practice address
9730 Summers Ridge Rd
San Diego, CA 92121-3101
Phone
(858) 549-7400
NPI assigned
Apr 25, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2017

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

Authorized official

Name
Andrew L Chang, M.D.NPI 1255513859
Title
President
Phone
(951) 533-4889

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
Radiation Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0001X Primary

Addresses

Primary practice location

9730 Summers Ridge Rd
San Diego, CA 92121-3101

Mailing address

PO Box 270219
San Diego, CA 92198-2219

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171005003071 CA Part B Supplier - Clinic/Group Practice 7214202936 Receives reassigned benefits from 20 practitioners
Practice locations: San Diego, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2148257Proton Doctors Professional Corporation9730 Summers Ridge Rd, San Diego, CA 92121Certificate of waiverMay 6, 2028

National Provider Directory

National Provider Directory

Locations

9730 Summers Ridge Rd
#101
San Diego, CA 92121
Phone (858) 549-7458

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1493078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503273600000",
    "number": "1093240285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270219",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921982219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9730 SUMMERS RIDGE RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213101",
            "telephone_number": "858-549-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROTON DOCTORS PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-25",
        "last_updated": "2017-08-21",
        "status": "A",
        "authorized_official_last_name": "CHANG",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "951-533-4889",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Radiation Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 21, 2017; 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.