NPIMap

Organization Active NPI

Memorialcare Medical Group, Inc.

  • Non-Pharmacy Dispensing Site
  • Irvine, CA
National Provider Identifier
1215079298
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
G21256 Issued in CA
Legal business name
MEMORIALCARE MEDICAL GROUP, INC.
Practice address
4050 Barranca Pkwy
Suite 200
Irvine, CA 92604-7706
Phone
(949) 551-1090
NPI assigned
Feb 13, 2007
Organization subpart
Yes
Parent organization
MEDVANTX, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X G21256 CA Primary

Addresses

Primary practice location

4050 Barranca Pkwy
Suite 200
Irvine, CA 92604-7706

Mailing address

9276 Scranton Rd
Suite 100
San Diego, CA 92121-7701
Phone (858) 625-2990

Other names 1

  • MemorialCare Medical Group - Irvine - Yale Loop Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0581820Memorialcare Medical Group4050 Barranca Pkwy, Suite 200, Irvine, CA 92604Provider-performed microscopyDec 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
BPMG - Costa Mesa9 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1215079298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9276 SCRANTON RD",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921217701",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 BARRANCA PKWY",
            "address_2": "SUITE 200",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926047706",
            "telephone_number": "949-551-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIALCARE MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC",
        "enumeration_date": "2007-02-13",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "G21256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MemorialCare Medical Group - Irvine - Yale Loop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.