Organization Active NPI

Neil L. Halim, MD Inc.

  • Family Medicine Physician
  • San Marcos, CA
National Provider Identifier
1124392683
Registry record updated Mar 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
C53327 Issued in CA
Legal business name
NEIL L. HALIM, MD INC.
Practice address
1030 La Bonita Dr
Suite 316
San Marcos, CA 92078-5291
Phone
(760) 744-9626
Fax
(760) 744-0751
NPI assigned
Mar 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2012

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

Authorized official

Name
Neil L Halim, M.D.NPI 1689623548
Title
Owner
Phone
(318) 230-5487

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X C53327 CA Primary

Addresses

Primary practice location

1030 La Bonita Dr
Suite 316
San Marcos, CA 92078-5291

Mailing address

1030 La Bonita Dr
Suite 316
San Marcos, CA 92078-5291
Phone (760) 744-9626

Other names 1

  • Lake San Marcos Family Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120306000332 CA Part B Supplier - Clinic/Group Practice 9931368214 Receives reassigned benefits from 1 practitioner
Practice locations: San Marcos, 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
05D2042367Lake San Marcos Family Medicine1030 La Bonita Dr Ste 316, San Marcos, CA 92078Provider-performed microscopyJun 10, 2028

National Provider Directory

National Provider Directory

Locations

1030 La Bonita Dr
Ste 316
San Marcos, CA 92078
Phone (760) 744-9626

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 1

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": "1330560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330560000000",
    "number": "1124392683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 LA BONITA DR",
            "address_2": "SUITE 316",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920785291",
            "telephone_number": "760-744-9626",
            "fax_number": "760-744-0751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 LA BONITA DR",
            "address_2": "SUITE 316",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920785291",
            "telephone_number": "760-744-9626",
            "fax_number": "760-744-0751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIL L. HALIM, MD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-01",
        "last_updated": "2012-03-01",
        "status": "A",
        "authorized_official_last_name": "HALIM",
        "authorized_official_first_name": "NEIL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "318-230-5487",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "C53327",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake San Marcos Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Marcos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; 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.