Individual provider Active NPI

David P. Dimmock, M.D.

  • Clinical Biochemical Genetics Physician
  • San Diego, CA
National Provider Identifier
1275796419
Registry record updated Jul 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Biochemical Genetics PhysicianTaxonomy code 207SG0202X
License
C146669 Issued in CA
Practice address
3030 Childrens Way
San Diego, CA 92123-4232
Phone
(800) 788-9029
Fax
(858) 966-8092
NPI assigned
Jul 8, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Genetics (M.D.) Physician 207SG0201X C146669 CA
Pediatrics Physician 208000000X C146669 CA
Clinical Biochemical Genetics Physician 207SG0202X C146669 CA Primary

Addresses

Primary practice location

3030 Childrens Way
San Diego, CA 92123-4232

Mailing address

3030 Childrens Way
San Diego, CA 92123-4232
Phone (800) 788-9029

Other practice location 1

9300 Valley Childrens Pl
Madera, CA 93636-8761
Phone (559) 353-6700

Other identifiers 1

IdentifierTypeStateIssuer
1275796419MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180214001529 CA Practitioner - Medical Genetics and Genomics 7517033707 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical Genetics and Genomics
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Childrens Medical GroupGroup PAC ID 9032439336, 50 clinicians

Practice addresses (Care Compare)

1524 McHenry Ave
Modesto, CA 95350-4500
Phone (209) 572-3880

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
C146669CAMDClinical Biochemical Genetics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Children'S Medical Group Pediatrics CurrentSince Jul 5, 2023 Accepting new patients
University Hospitals Cleveland Medical Center Past Accepting new patients

Locations

9300 Valley Childrens Pl
Madera, CA 93636
Phone (559) 353-5700

9300 Valley Childrens Pl
#5
Madera, CA 93636
Phone (559) 353-5700

1524 McHenry Ave
Ste 550570
Modesto, CA 95350
Phone (209) 572-3880

Interoperability endpoints

  • Direct secure messaging: ddimmock64795@valleychildrens-prd.direct-ci.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1215475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657756800000",
    "number": "1275796419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3030 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234232",
            "telephone_number": "800-788-9029",
            "fax_number": "858-966-8092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234232",
            "telephone_number": "800-788-9029",
            "fax_number": "858-966-8092"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9300 Valley Childrens Pl",
            "address_purpose": "LOCATION",
            "city": "Madera",
            "state": "CA",
            "postal_code": "936368761",
            "country_code": "US",
            "telephone_number": "559-353-6700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIMMOCK",
        "first_name": "DAVID",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-08",
        "last_updated": "2022-07-14",
        "certification_date": "2022-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "CA",
            "license": "C146669",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C146669",
            "primary": false
        },
        {
            "code": "207SG0202X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Biochemical Genetics",
            "state": "CA",
            "license": "C146669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1275796419",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.