Team Physicians of Southern California Medical Group, Inc.
Organization Active NPI Emergency Medicine Physician · Oceanside, CA
NPI 1225499015 · NPPES record last updated Jan 10, 2020
Key facts
- NPI
- 1225499015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- TEAM PHYSICIANS OF SOUTHERN CALIFORNIA MEDICAL GROUP, INC.
- Practice address
- 4002 Vista Way
Oceanside, CA 92056-4506 - Phone
- (925) 924-1600
- Fax
- (925) 924-0506
- NPI assigned
- Mar 8, 2016
- Organization subpart
- No
Authorized official
- Name
- Kristopher M. Smith
- Title
- Cfo
- Phone
- (925) 924-1600
Practitioners 183
-
Sara Amen, MD
-
Allison Auchter, MD, PHD
-
Taylor Bashara, MD
-
Eli Rainier Lipscomb, FNP
-
Matthew Gene Allen, PA-C
-
Lindsey Ball, MD
-
Rica Bonomo, M.D.
-
Dorothy W. Brown, M.D.
-
Neil J. Tomaneng, M.D.
-
Lily Vartanyan, MD
-
Jailyn Elizabeth Avila, M.D.
-
Hrak Derderian, M.D.
-
Alexander Hoerig, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160816003061 | CA | Part B Supplier - Clinic/Group Practice | 0446545354 |
Receives reassigned benefits from 182 practitioners Practice locations: Glendale, CA; Oceanside, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
4002 Vista Way
Oceanside, CA 92056-4506
Mailing address
5000 Hopyard Rd
Suite 100
Pleasanton, CA 94588-3348
Phone (925) 924-1600
Other providers in Oceanside, CA
- Phyllis Jean Taylor
- Timothy Justin Taylor
- Aaron Tayman
- Adam Tayman
- TCM Acupuncture & Herbs Center Co
- Michael W Teel
- Roy Vincent Tejidor
- Joshua M Telsey
- Briana Temblador
- Quintin Dean Tennant
All providers in Oceanside, CA · Emergency 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 Jan 10, 2020. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.