Individual provider Active NPI

James Wickham, MD

  • Anesthesiology Physician
  • Mission Viejo, CA
National Provider Identifier
1104864941
Registry record updated Jan 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
G69601 Issued in CA
Practice address
27401 Los Altos
Suite 180
Mission Viejo, CA 92691-6316
Phone
(949) 582-9624
Fax
(949) 582-9626
NPI assigned
Jun 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G69601 CA Primary

Addresses

Primary practice location

27401 Los Altos
Suite 180
Mission Viejo, CA 92691-6316

Mailing address

27401 Los Altos
Suite 180
Mission Viejo, CA 92691-6316
Phone (949) 582-9624

Other identifiers 1

IdentifierTypeStateIssuer
00G696010MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100407000398 CA Practitioner - Anesthesiology 0648306290 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of California, Geffen School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Western Anesthesia Medical Associates IncGroup PAC ID 7012902216, 49 clinicians

Practice addresses (Care Compare)

27700 Medical Ctr Rd
Mission Viejo, CA 92691-6426
Phone (949) 364-1400

31872 Coast Hwy
Laguna Beach, CA 92651-6773
Phone (949) 499-1311

Hospital & facility affiliations

  • Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Western Anesthesia Medical Associates Inc Anesthesiology CurrentSince Feb 10, 2000 Accepting new patients

Locations

27401 Los Altos
Ste 180
Mission Viejo, CA 92691
Phone (949) 582-9624

27700 Medical Center Rd
Mission Viejo, CA 92691
Phone (949) 364-7744

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201219200000",
    "number": "1104864941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27401 LOS ALTOS",
            "address_2": "SUITE 180",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916316",
            "telephone_number": "949-582-9624",
            "fax_number": "949-582-9626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27401 LOS ALTOS",
            "address_2": "SUITE 180",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916316",
            "telephone_number": "949-582-9624",
            "fax_number": "949-582-9626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKHAM",
        "first_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2008-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G69601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G696010",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mission Viejo, CA

Sources for this page

Verify at the official NPI Registry.