Organization Active NPI

K. Mitchell Naficy MD Inc

  • Family Medicine Physician
  • San Juan Capistrano, CA
National Provider Identifier
1255490678
Registry record updated Oct 26, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
G72771 Issued in CA
Legal business name
K. MITCHELL NAFICY MD INC
Practice address
27512 Calle Arroyo
Suite a
San Juan Capistrano, CA 92675-2753
Phone
(949) 489-0773
Fax
(949) 489-9342
NPI assigned
Dec 8, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2010

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

Authorized official

Name
Dr. K. Mitchell Naficy, M.D.NPI 1699755264
Title
President
Phone
(949) 489-0773

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X G72771 CA Primary

Addresses

Primary practice location

27512 Calle Arroyo
Suite a
San Juan Capistrano, CA 92675-2753

Mailing address

27512 Calle Arroyo
Suite a
San Juan Capistrano, CA 92675-2753
Phone (949) 489-0773

Other identifiers 1

IdentifierTypeStateIssuer
00G727710MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040310000637 CA Part B Supplier - Clinic/Group Practice 2365330362 Receives reassigned benefits from 2 practitioners
Practice locations: San Juan Capistrano, CA

National Provider Directory

National Provider Directory

Locations

27512 Calle Arroyo
Ste A
San Juan Capistrano, CA 92675
Phone (949) 388-8011

27512 Calle Arroyo
Ste D
San Juan Capistrano, CA 92675
Phone (949) 489-0773

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": "1165536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288051200000",
    "number": "1255490678",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27512 CALLE ARROYO",
            "address_2": "SUITE A",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926752753",
            "telephone_number": "949-489-0773",
            "fax_number": "949-489-9342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27512 CALLE ARROYO",
            "address_2": "SUITE A",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926752753",
            "telephone_number": "949-489-0773",
            "fax_number": "949-489-9342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K. MITCHELL NAFICY MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-08",
        "last_updated": "2010-10-26",
        "status": "A",
        "authorized_official_last_name": "NAFICY",
        "authorized_official_first_name": "K. MITCHELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-489-0773",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G72771",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G727710",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan Capistrano, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2010; 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.