NPIMap

Organization Active NPI

Gospha G, Campbell MD Inc

  • Adult Medicine Physician
  • San Bernardino, CA
National Provider Identifier
1215182803
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
A 102029 Issued in CA
Legal business name
GOSPHA G, CAMPBELL MD INC
Practice address
1850 S Waterman Ave # F
San Bernardino, CA 92408-2877
Phone
(909) 890-9393
Fax
(909) 890-9394
NPI assigned
Nov 24, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Authorized official

Name
Gospha G Campbell, MDNPI 1306012935
Title
Physician
Phone
(909) 890-9393

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QA0505X A 102029 CA Primary

Addresses

Primary practice location

1850 S Waterman Ave # F
San Bernardino, CA 92408-2877

Mailing address

1850 S Waterman Ave, # F
San Bernardino, CA 92408-2464
Phone (909) 890-9393

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090812000892 CA Part B Supplier - Clinic/Group Practice 5698829471 Receives reassigned benefits from 1 practitioner
Practice locations: San Bernardino, CA

National Provider Directory

National Provider Directory

Locations

1850 S Waterman Ave
San Bernardino, CA 92408
Phone (909) 890-9393

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)…

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1227484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1215182803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 S WATERMAN AVE, # F",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082464",
            "telephone_number": "909-890-9393",
            "fax_number": "909-890-9394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 S WATERMAN AVE # F",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924082877",
            "telephone_number": "909-890-9393",
            "fax_number": "909-890-9394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOSPHA G, CAMPBELL MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-24",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "GOSPHA",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "909-890-9393",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "A 102029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2012; 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.