Specialty Medical Center, Inc

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

A49785 Issued in CA

Legal business name

SPECIALTY MEDICAL CENTER, INC

Practice address

1401 S Brookhurst Rd
Suit 100
Fullerton, CA 92833

Phone

(714) 626-0700

Fax

(714) 626-0800

NPI assigned

Aug 24, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mark Myungjae Song, MDNPI 1326068560

Title

Physician/Sole Owner

Phone

(701) 626-0700

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

Locations

Practitioners 1

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

• Mark Myungjae Song, MD, PHD

  • Nephrology Physician
  • Los Angeles, CA
  • NPI 1326068560
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294963200000",
    "number": "1104933183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 S BROOKHURST RD",
            "address_2": "SUIT 100",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92833",
            "telephone_number": "714-626-0700",
            "fax_number": "714-626-0800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 S BROOKHURST RD",
            "address_2": "SUIT 100",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "92833",
            "telephone_number": "714-626-0700",
            "fax_number": "714-626-0800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECIALTY MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2011-01-14",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "MYUNGJAE",
        "authorized_official_title_or_position": "PHYSICIAN/SOLE OWNER",
        "authorized_official_telephone_number": "701-626-0700",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A49785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A497850",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern California Permanente Medical Group
• Maren Radcliffe Ross Sowerby, MD
• Sydney Soy
• Paige Sparrow, OTR/L
• Specialized Community Healthcare Company
• Cassidy Spillett
• Angelina Elizabeth Spinuzzi
• Spring Home Health
• Richard Lynn Spurlock
• Pretty Joy Ssebakijje

• Nephrology Physician in Fullerton, CA
• Providers in Fullerton, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2011; 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.