Solomon Teckle, M.D.
Individual provider Active NPI Family Medicine Physician · Ventura, CA
NPI 1154582971 · NPPES record last updated Nov 18, 2009
Key facts
- NPI
- 1154582971
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- A104612 (CA)
- Practice address
- 3291 Loma Vista Rd
Ventura, CA 93003-3099 - Phone
- (805) 652-6228
- NPI assigned
- Jun 24, 2008
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Oregon Health Sciences University School of Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
4101 Charlotte Ave
Suite F185
Nashville, TN 37209-3990
6550 Carothers Pkwy
Suite 225
Franklin, TN 37067-6369
PO Box
Franklin, TN 37068
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (4 enrollments) in CA, GA, TN, LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100526000260 | CA | Practitioner - Family Practice | 1456480698 | Reassigns benefits to 3 organizations |
| I20120927000422 | GA | Practitioner - Family Practice | 1456480698 | Reassigns benefits to 6 organizations |
| I20260327003461 | TN | Practitioner - Family Practice | 1456480698 | Reassigns benefits to 4 organizations |
| I20260331000663 | LA | Practitioner - Family Practice | 1456480698 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A104612 | CA | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peachtree Immediate Care FP, LLC | Family Medicine | Current |
Accepting new patients |
| Adobe PH Ca Medical Group, P.C. | Family Medicine | Current |
Accepting new patients |
Locations
135 S State College Blvd
#228
Brea, CA 92821
1480 Baxter St
Ste A
Athens, GA 30606
Phone (706) 543-0228
450 14th St NW
Atlanta, GA 30318
Phone (404) 480-9797
4400 Peachtree Rd NE
Brookhaven, GA 30319
Phone (404) 814-9199
1829 Lawrenceville Hwy
Ste A
Decatur, GA 30033
Phone (404) 292-8335
590 Lanier Ave W
Fayetteville, GA 30214
3827 Jimmy Lee Smith Pkwy
Hiram, GA 30141
Phone (770) 222-8900
Interoperability endpoints
- solomon.teckle@wellbe.gadirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A104612 | CA | Yes |
Addresses
Primary practice location
3291 Loma Vista Rd
Ventura, CA 93003-3099
Mailing address
3291 Loma Vista Rd
Ventura, CA 93003-3099
Phone (805) 981-5181
NPI Registry JSON
{
"created_epoch": "1214265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258502400000",
"number": "1154582971",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3291 LOMA VISTA RD",
"city": "VENTURA",
"state": "CA",
"postal_code": "930033099",
"telephone_number": "805-981-5181"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3291 LOMA VISTA RD",
"city": "VENTURA",
"state": "CA",
"postal_code": "930033099",
"telephone_number": "805-652-6228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TECKLE",
"first_name": "SOLOMON",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-24",
"last_updated": "2009-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CA",
"license": "A104612",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ventura, CA
- Marisa Erin Taylor
- Meghan Marie Taylor
- Thomas Taylor
- Heather Te
- Emily Teague
- Dominic J. Tedesco
- Telecare Corporation
- Telecare Vista Voice
- Victor Angel Tellez
- Daniel B Tello
All providers in Ventura, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 18, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.