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Individual provider Active NPI

Mansour Mofidi, DO

  • Internal Medicine Physician
  • La Mesa, CA
National Provider Identifier
1164598843
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A7485 Issued in CA
Practice address
5555 Grossmont Center Dr
La Mesa, CA 91942-3019
Phone
(619) 740-6000
NPI assigned
Nov 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20A7485 CA Primary

Addresses

Primary practice location

5555 Grossmont Center Dr
La Mesa, CA 91942-3019

Mailing address

PO Box 2303
La Mesa, CA 91943-2303
Phone (888) 664-8297

Other practice location 1

5555 Grossmont Center Dr
LA Mesa, CA 91942-3019
Phone (619) 857-2569

Other identifiers 1

IdentifierTypeStateIssuer
0007441277OtherAETNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090520000158 CA Practitioner - Internal Medicine 0143379222 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Western University of Health Sciences College of Dental Med, 1998
Medicare assignment
May accept Medicare assignment
Group practices
Mansour Mofidi DO IncGroup PAC ID 7315085149, 2 clinicians

Practice addresses (Care Compare)

5555 Grossmont Ctr Dr
La Mesa, CA 91942-3019
Phone (619) 740-4500

Hospital & facility affiliations

  • Archer Health Inc Home health agency, Carlsbad, CA, CCN 053124
  • Comfort and Peace Hospice Hospice, San Diego, CA, CCN A01593
  • Vitas Healthcare Corporation of California Hospice, San Diego, CA, CCN 051597
  • Grossmont Hospital Hospital, La Mesa, CA, CCN 050026
  • Palomar Health Downtown Campus Hospital, Escondido, CA, CCN 050115
  • Grossmont Hospital Sharp Inpatient rehabilitation facility, La Mesa, CA, CCN 05T026
  • Select Specialty Hospital - San Diego Long-term care hospital, San Diego, CA, CCN 052044
  • Villa Las Palmas Healthcare Center Nursing home, El Cajon, CA, CCN 055806
  • Cottonwood Canyon Healthcare Center Nursing home, El Cajon, CA, CCN 055064
  • Mount Miguel Covenant Village Nursing home, Spring Valley, CA, CCN 555134
  • Arbor Hills Nursing Center Nursing home, La Mesa, CA, CCN 055114
  • Country Manor la Mesa Healthcare Center Nursing home, La Mesa, CA, CCN 055910

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A7485CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency and Acute Care Medical Corporation CurrentSince Oct 1, 2014 Accepting new patients
Careconnectmd Ca PC CurrentSince Aug 9, 2024 Accepting new patients
Mansour Mofidi, D.O.,Inc Internal Medicine CurrentSince Feb 15, 2009 Accepting new patients
San Diego Critical Care Medical Group, Inc Internal Medicine CurrentSince Dec 1, 2024 Accepting new patients

Locations

751 Medical Center Ct
Chula Vista, CA 91911
Phone (619) 482-3639

3090 Bristol St
Ste 200
Costa Mesa, CA 92626
Phone (714) 992-1182

1391 E Madison Ave
El Cajon, CA 92021
Phone (616) 444-1107

5555 Grossmont Center Dr
La Mesa, CA 91942
Phone (619) 465-0711

5119 Garfield St
La Mesa, CA 91941
Phone (619) 460-4055

8880 Rio San Diego Dr
Fl 8
San Diego, CA 92108
Phone (619) 500-6282

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

473 E Carnegie Dr
Ste 200
Sn Bernrdno, CA 92408
Phone (562) 803-4500

473 S Carnegie Dr
Ste 200
Sn Bernrdno, CA 92408
Phone (562) 803-4500

Ownership & related parties

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Villa Las Palmas Healthcare CenterEl Cajon, CA, CCN 055806 Skilled nursing facility Contracted Managing Employee Jul 1, 2023
Cottonwood Canyon Healthcare CenterEl Cajon, CA, CCN 055064 Skilled nursing facility Contracted Managing Employee Oct 1, 2022

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 4

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1164598843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2303",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919432303",
            "telephone_number": "888-664-8297",
            "fax_number": "412-857-3568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 GROSSMONT CENTER DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423019",
            "telephone_number": "619-740-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5555 Grossmont Center Dr",
            "address_purpose": "LOCATION",
            "city": "LA Mesa",
            "state": "CA",
            "postal_code": "919423019",
            "country_code": "US",
            "telephone_number": "619-857-2569",
            "fax_number": "619-337-3820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MOFIDI",
        "first_name": "MANSOUR",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A7485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0007441277",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.