NPIMap

Organization Active NPI

Regents of the Unviersity of California

  • Emergency Medicine Physician
  • National City, CA
National Provider Identifier
1275722415
Registry record updated Aug 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
REGENTS OF THE UNVIERSITY OF CALIFORNIA
Practice address
2400 E 4TH St
National City, CA 91950-2026
Phone
(619) 470-4321
NPI assigned
Oct 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2020

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

Authorized official

Name
Theodore C Chan, M.D.
Title
Authorized Official / Director
Phone
(619) 543-6463

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207P00000X CA Primary

Addresses

Primary practice location

2400 E 4TH St
National City, CA 91950-2026

Mailing address

File No 54826
Los Angeles, CA 90074-0001
Phone (888) 486-4380

Other identifiers 1

IdentifierTypeStateIssuer
GR0069870MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000940 CA Part B Supplier - Clinic/Group Practice 6406760131 Receives reassigned benefits from 221 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: San Diego, CA; La Jolla, CA; Encinitas, CA; El Centro, CA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

File No 54826
Los Angeles, CA 90074

Practitioners & affiliated clinicians

Practitioners 20

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.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1193097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596672000000",
    "number": "1275722415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE NO 54826",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001",
            "telephone_number": "888-486-4380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 E 4TH ST",
            "city": "NATIONAL CITY",
            "state": "CA",
            "postal_code": "919502026",
            "telephone_number": "619-470-4321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS OF THE UNVIERSITY OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-23",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL / DIRECTOR",
        "authorized_official_telephone_number": "619-543-6463",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0069870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in National City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; 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.