NPIMap

Organization Active NPI

Cassidy Medical Group -Peds

  • Pediatrics Physician
  • Vista, CA
National Provider Identifier
1235206293
Registry record updated Oct 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
CASSIDY MEDICAL GROUP -PEDS
Practice address
2067 W Vista Way Ste 280
Vista, CA 92083-6034
Phone
(760) 941-3630
Fax
(760) 941-1214
NPI assigned
Nov 28, 2006
Organization subpart
Yes
Parent organization
CASSIDY MEDICAL GROUP INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 13, 2010

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

Authorized official

Name
Judith M Krueger
Title
Executive Director
Phone
(760) 630-5487

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

2067 W Vista Way Ste 280
Vista, CA 92083-6034

Mailing address

2067 W Vista Way Ste 280
Vista, CA 92083-6034
Phone (760) 941-3630

Other identifiers 1

IdentifierTypeStateIssuer
W41833AOtherMEDICARE PTAN

National Provider Directory

National Provider Directory
Tax ID family
Cassidy Medical Group - SW5 organizations share this tax ID, including this one
Part of
Cassidy Medical Group - SW

Other organizations with this tax ID 4

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286928000000",
    "number": "1235206293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2067 W VISTA WAY STE 280",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836034",
            "telephone_number": "760-941-3630",
            "fax_number": "760-941-1214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2067 W VISTA WAY STE 280",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836034",
            "telephone_number": "760-941-3630",
            "fax_number": "760-941-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASSIDY MEDICAL GROUP -PEDS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CASSIDY MEDICAL GROUP INC.",
        "enumeration_date": "2006-11-28",
        "last_updated": "2010-10-13",
        "status": "A",
        "authorized_official_last_name": "KRUEGER",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "760-630-5487"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "W41833A",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.