Organization Active NPI

Crown Island Family Practice a Medical Corporation

  • Family Medicine Physician
  • Coronado, CA
National Provider Identifier
1265855506
Registry record updated Oct 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
20A6446 Issued in CA
Legal business name
CROWN ISLAND FAMILY PRACTICE A MEDICAL CORPORATION
Practice address
230 Prospect PL
Suite 350
Coronado, CA 92118-1978
Phone
(619) 537-6910
Fax
(619) 537-6905
NPI assigned
Jan 22, 2014
Last updated
Oct 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2022

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

Authorized official

Name
Dr. Kevin Considine, D.O.NPI 1215918271
Title
Medical Director
Phone
(619) 537-6910

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 Physician 207Q00000X 20A6446 CA Primary

Addresses

Primary practice location

230 Prospect PL
Suite 350
Coronado, CA 92118-1978

Mailing address

230 Prospect PL
Suite 350
Coronado, CA 92118-1978
Phone (619) 537-6910

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140528001782 CA Part B Supplier - Clinic/Group Practice 3870716400 Receives reassigned benefits from 1 practitioner
Practice locations: Coronado, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2075596Crown Island Family Practice230 Prospect PL Ste 350, Coronado, CA 92118Certificate of waiverMar 31, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1390348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1265855506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 PROSPECT PL",
            "address_2": "SUITE 350",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921181978",
            "telephone_number": "619-537-6910",
            "fax_number": "619-537-6905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 PROSPECT PL",
            "address_2": "SUITE 350",
            "city": "CORONADO",
            "state": "CA",
            "postal_code": "921181978",
            "telephone_number": "619-537-6910",
            "fax_number": "619-537-6905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROWN ISLAND FAMILY PRACTICE A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-22",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "CONSIDINE",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "619-537-6910",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A6446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coronado, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.