Individual provider Active NPI

Paige Alexandra Thiermann, MD

  • Family Medicine Physician
  • El Cajon, CA
National Provider Identifier
1134411432
Registry record updated Sep 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A114779 Issued in CA
Practice address
855 E Madison Ave
El Cajon, CA 92020-3819
Phone
(619) 440-2751
NPI assigned
May 5, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A114779 CA Primary

Addresses

Primary practice location

855 E Madison Ave
El Cajon, CA 92020-3819

Mailing address

425 N Date St
Escondido, CA 92025-3413
Phone (760) 737-6960

Other identifiers 2

IdentifierTypeStateIssuer
GJ432ZOtherCAMEDICARE PTAN
W14158OtherCAGROUP PTAN

Other names 1

  • Paige Alexandra Dekoster Former name

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
I20120821000217 CA Practitioner - Family Practice 7911154372 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Albany Medical College of Union University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Neighborhood HealthcareGroup PAC ID 5294649406, 153 clinicians

Practice addresses (Care Compare)

855 E Madison Ave
El Cajon, CA 92020-3819
Phone (619) 440-2751

Hospital & facility affiliations

  • Grossmont Hospital Hospital, La Mesa, CA, CCN 050026

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A114779CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Neighborhood Healthcare General Practice CurrentSince Aug 1, 2012 Accepting new patients
Neighborhood Healthcare General Practice CurrentSince Aug 1, 2012 Accepting new patients

Locations

855 E Madison Ave
El Cajon, CA 92020
Phone (619) 440-2751

425 N Date St
Escondido, CA 92025
Phone (760) 737-2035

425 N Date St
#0
Escondido, CA 92025

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 2

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 1

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": "1304553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346716800000",
    "number": "1134411432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 N DATE ST",
            "city": "ESCONDIDO",
            "state": "CA",
            "postal_code": "920253413",
            "telephone_number": "760-737-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 E MADISON AVE",
            "city": "EL CAJON",
            "state": "CA",
            "postal_code": "920203819",
            "telephone_number": "619-440-2751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THIERMANN",
        "first_name": "PAIGE",
        "middle_name": "ALEXANDRA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-05",
        "last_updated": "2012-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A114779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "GJ432Z",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PTAN",
            "identifier": "W14158",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PAIGE",
            "last_name": "DEKOSTER",
            "middle_name": "ALEXANDRA",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in El Cajon, CA

Sources for this page

Verify at the official NPI Registry.