NPIMap

Organization Active NPI

Southern California Kidney Consultants Inc.

  • Nephrology Physician
  • Garden Grove, CA
National Provider Identifier
1205934783
Registry record updated Oct 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
G24122 Issued in CA
Legal business name
SOUTHERN CALIFORNIA KIDNEY CONSULTANTS INC.
Practice address
12665 Garden Grove Blvd
Ste 211
Garden Grove, CA 92843-1901
Phone
(714) 636-2890
Fax
(714) 636-2909
NPI assigned
Sep 20, 2006
Last updated
Oct 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2018

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

Authorized official

Name
Elizabeth A Gonzalez
Title
Administrator
Phone
(714) 636-2890

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X G24122 CA Primary

Addresses

Primary practice location

12665 Garden Grove Blvd
Ste 211
Garden Grove, CA 92843-1901

Mailing address

12665 Garden Grove Blvd
Ste 211
Garden Grove, CA 92843-1901
Phone (714) 636-2890

Other practice location 1

5451 La Palma Ave Ste 47
LA Palma, CA 90623-1732
Phone (714) 562-8560

Other practice location 2

100 E Valencia Mesa Dr Ste 217
Fullerton, CA 92835-3800
Phone (714) 992-5581

Other practice location 3

1019 W La Palma Ave Unit A
Anaheim, CA 92801-3664
Phone (714) 956-5200

Other practice location 4

1310 W Stewart Dr Ste 210
Orange, CA 92868-3837
Phone (714) 836-4204

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040417000613 CA Part B Supplier - Clinic/Group Practice 6103811286 Receives reassigned benefits from 29 practitioners
Practice locations: Garden Grove, CA

National Provider Directory

National Provider Directory

Locations

100 E Valencia Mesa Dr
Ste 110
Fullerton, CA 92835
Phone (714) 778-1032

12665 Garden Grove Blvd
#217
Garden Grove, CA 92843

721 W 1st St
Tustin, CA 92780
Phone (714) 544-0079

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/21072/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539648000000",
    "number": "1205934783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "STE 211",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431901",
            "telephone_number": "714-636-2890",
            "fax_number": "714-636-2909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD",
            "address_2": "STE 211",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431901",
            "telephone_number": "714-636-2890",
            "fax_number": "714-636-2909"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5451 La Palma Ave Ste 47",
            "address_purpose": "LOCATION",
            "city": "LA Palma",
            "state": "CA",
            "postal_code": "906231732",
            "country_code": "US",
            "telephone_number": "714-562-8560",
            "fax_number": "714-562-8563",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "100 E Valencia Mesa Dr Ste 217",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928353800",
            "country_code": "US",
            "telephone_number": "714-992-5581",
            "fax_number": "714-992-2950",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1019 W La Palma Ave Unit A",
            "address_purpose": "LOCATION",
            "city": "Anaheim",
            "state": "CA",
            "postal_code": "928013664",
            "country_code": "US",
            "telephone_number": "714-956-5200",
            "fax_number": "714-956-4614",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1310 W Stewart Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Orange",
            "state": "CA",
            "postal_code": "928683837",
            "country_code": "US",
            "telephone_number": "714-836-4204",
            "fax_number": "714-836-1809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA KIDNEY CONSULTANTS INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2018-10-16",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "714-636-2890"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "G24122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2018; 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.