NPIMap

Organization Active NPI

Prisma Care, a Medical Corporation

  • Internal Medicine Physician
  • Chula Vista, CA
National Provider Identifier
1093809139
Registry record updated Jul 15, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A43301 Issued in CA
Legal business name
PRISMA CARE, A MEDICAL CORPORATION
Practice address
2648 Main St
Suite #a
Chula Vista, CA 91911-4664
Phone
(619) 575-5000
Fax
(619) 575-5060
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2009

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

Authorized official

Name
Jose R LopezNPI 1568667228
Title
President
Phone
(619) 575-5000

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X A43301 CA Primary

Addresses

Primary practice location

2648 Main St
Suite #a
Chula Vista, CA 91911-4664

Mailing address

2648 Main St
Suite #a
Chula Vista, CA 91911-4664
Phone (619) 575-5000

Other identifiers 1

IdentifierTypeStateIssuer
00A433010MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090720000009 CA Part B Supplier - Clinic/Group Practice 1658423801 Receives reassigned benefits from 1 practitioner
Practice locations: Chula Vista, CA

National Provider Directory

National Provider Directory

Locations

1660 Broadway
Ste 10
Chula Vista, CA 91911
Phone (619) 498-3755

4184 Beyer Blvd
Ste 105
San Ysidro, CA 92173

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247616000000",
    "number": "1093809139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2648 MAIN ST",
            "address_2": "SUITE #A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919114664",
            "telephone_number": "619-575-5000",
            "fax_number": "619-575-5060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2648 MAIN ST",
            "address_2": "SUITE #A",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919114664",
            "telephone_number": "619-575-5000",
            "fax_number": "619-575-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISMA CARE, A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2009-07-15",
        "status": "A",
        "authorized_official_last_name": "LOPEZ",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-575-5000"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A43301",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A433010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2009; 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.