Active NPI
John H Detwiler, M.D.
- Cardiovascular Disease Physician
- Escondido, CA
National Provider Identifier
1154324036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- G23336
- Practice address
- 1955 W Citracado Pkwy
Suite 300
Escondido, CA 92029-4113 - Phone
- (760) 743-0546
- Fax
- (760) 743-8837
- NPI assigned
- May 24, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | G23336 | CA | Primary |
| Interventional Cardiology Physician | 207RI0011X | G23336 | CA |
Addresses
Primary practice location
1955 W Citracado Pkwy
Suite 300
Escondido, CA 92029-4113
Mailing address
PO Box 28199
San Diego, CA 92198-0199
Phone (858) 673-2574
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060020994 | Other | RR MEDICARE | |
| 1154324036 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23336 | CA | MD | Addiction (Substance Use Disorder) Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Escondido Cardiology Associates Medical Group, Inc. | Past | Accepting new patients |
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.
-
- Specialist
- Escondido, CA
- NPI 1437121183
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349654400000",
"number": "1154324036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28199",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921980199",
"telephone_number": "858-673-2574",
"fax_number": "858-618-1523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1955 W CITRACADO PKWY",
"address_2": "SUITE 300",
"city": "ESCONDIDO",
"state": "CA",
"postal_code": "920294113",
"telephone_number": "760-743-0546",
"fax_number": "760-743-8837"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETWILER",
"first_name": "JOHN",
"middle_name": "H",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-24",
"last_updated": "2012-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "CA",
"license": "G23336",
"primary": true
},
{
"code": "207RI0011X",
"taxonomy_group": "",
"desc": "Internal Medicine, Interventional Cardiology",
"state": "CA",
"license": "G23336",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "060020994",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1154324036",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Escondido, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.