Philip J. Fagan Jr., M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

C32505 Issued in CA

Practice address

14642 Newport Ave Ste 101
Tustin, CA 92780-6058

Phone

(714) 581-6470

Fax

(714) 581-6492

NPI assigned

Jun 8, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in CA, NV2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• California Hospitalists Emergency Physicians Medical Group Inc

  • Emergency Medicine Physician
  • Norwalk, CA
  • NPI 1760648539
  Medicare reassignment NPD Authorized official
• Can Emergency Physicians Medical Group, Inc.

  • Emergency Medicine Physician
  • Panorama City, CA
  • NPI 1265810006
  Medicare reassignment NPD Authorized official
• ER Physicians Medical Group, Inc.

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1063765907
  Medicare reassignment Authorized official
• Glenn Medical Center, LLC

  • Medicare Defined Swing Bed Hospital Unit
  • Willows, CA
  • NPI 1336187178
  Medicare reassignment NPD
• KND Development 59 LLC

  • Hospitalist Physician
  • Santa Ana, CA
  • NPI 1740519081
  Medicare reassignment NPD
• Hoover Emergency Physicians LLC

  • Emergency Medicine Physician
  • Boulder City, NV
  • NPI 1063713790
  Medicare reassignment NPD
• Can Emergency Physicians Medical Group Inc

  • Emergency Medicine Physician
  • Tustin, CA
  • NPI 1386018356
  NPD Authorized official
• Fagan ER Medical Group Inc

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1588689236
  NPD (past) Authorized official
• GCH Medical Group, Inc.

  • Emergency Medicine Physician
  • Long Beach, CA
  • NPI 1730567579
  Authorized official Same address or phone
• Glenn Medical Center, LLC

  dba Glenn Medical Rural Health Clinic

  • Rural Health Clinic/Center
  • Willows, CA
  • NPI 1255632790
  NPD
• Glenn Medical Center, LLC

  dba Family Care Center

  • Rural Health Clinic/Center
  • Willows, CA
  • NPI 1356388961
  NPD
• KND Develpment 59 LLC

  • Hospitalist Physician
  • West Covina, CA
  • NPI 1538498878
  NPD

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1255335154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2550 N HOLLYWOOD WAY STE 304",
            "city": "BURBANK",
            "state": "CA",
            "postal_code": "915055028",
            "telephone_number": "747-283-1809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE STE 101",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806058",
            "telephone_number": "714-581-6470",
            "fax_number": "714-581-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "PHILIP",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-08",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C32505",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "C32505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00C325050",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C325050",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALOPTIMA",
            "identifier": "00C325050",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930085818",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "C32505",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Everest Tustin Blessing Star LLC & SCHC (The Groves of Tustin)
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• Eye World Optometry
• F.Farshidi DDS MD Inc
• Baher Samir Fahmy, DDS.
• Daniel Falchetti, PT, MPT
• Nicka Fallah
• Families Together of Orange County (Families Together of Orange County-Mobile Clinic)
• Families Together of Orange County

• Emergency Medicine Physician in Tustin, CA
• Providers in Tustin, CA by specialty
• Emergency Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.