Shota Gurtch, M.D., Inc. a Professional Corporation

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SHOTA GURTCH, M.D., INC. A PROFESSIONAL CORPORATION

Practice address

8875 La Mesa Blvd Ste C
La Mesa, CA 91942-5434

Phone

(619) 668-8100

Fax

(619) 667-2688

NPI assigned

Jun 7, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Shota Gurchumelidze, MDNPI 1821284449

Title

Physician

Phone

(858) 997-3161

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Shota Gurtch MD Inc a Professional Corporation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Shota Gurtch, M.D., Inc., a Professional Corporation

  • Internal Medicine Physician
  • La Mesa, CA
  • NPI 1013792530
  NPD tax ID

Practitioners 1

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

• Shota Gurchumelidze, M.D.

  • Internal Medicine Physician
  • La Mesa, CA
  • NPI 1821284449
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1154050904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8875 LA MESA BLVD STE C",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425434",
            "telephone_number": "619-668-8100",
            "fax_number": "619-667-2688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8875 LA MESA BLVD STE C",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425434",
            "telephone_number": "619-668-8100",
            "fax_number": "619-667-2688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOTA GURTCH, M.D., INC. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-07",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "GURCHUMELIDZE",
        "authorized_official_first_name": "SHOTA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "858-997-3161",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jungook Devin Shin, M.D.
• Shirley J Lanyi PHD a Psychological Corp
• Jonathan Guillermo Shiroma, LMFT
• Ryan Shogan
• Richard Lee Short, M.D.
• Shota Gurtch, M.D., Inc., a Professional Corporation
• Shota Gurtch, M.D., Inc., a Professional Corporation
• Victoria G. Shuffelton, D.O.
• Bonnie Beth Shuman
• Manal Siddiq, MS, IMF

• Primary Care Clinic/Center in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; 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.