Daryl J Spak, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A166843 Issued in CA

Practice address

678 3Rd Ave
Chula Vista, CA 91910-5736

Phone

(619) 662-4100

NPI assigned

Jun 15, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centro de Salud de la Comunidad de San Ysidro,Inc.Group PAC ID 6901709435, 291 clinicians

24 On Physicians of California PCGroup PAC ID 7012228992, 58 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Pioneers Memorial Healthcare District Hospital, Brawley, CA, CCN 050342

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: dspak54813@syhealth.direct-ci.com

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.

• 24 On Physicians of California, PC

  • Hospitalist Physician
  • Porterville, CA
  • NPI 1730570565
  Medicare reassignment Care Compare group NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment Care Compare group NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  • Federally Qualified Health Center (FQHC)
  • Chula Vista, CA
  • NPI 1902587298
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  • Federally Qualified Health Center (FQHC)
  • National City, CA
  • NPI 1003869363
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Imperial Valley Healthcare District

  • General Acute Care Hospital
  • Brawley, CA
  • NPI 1184429185
  Care Compare affiliation

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

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1285128025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "678 3RD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919105736",
            "telephone_number": "619-662-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "678 3RD AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919105736",
            "telephone_number": "619-662-4100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2760 Godwin Blvd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Suffolk",
            "state": "VA",
            "postal_code": "234348501",
            "country_code": "US",
            "telephone_number": "579-838-6507",
            "fax_number": "757-983-8673",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPAK",
        "first_name": "DARYL",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-15",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101272707",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A166843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern California Fatty Liver Center Inc
• Southern California Health Providers Medical GRP Inc
• Southern Regional Resource Center
• Southwest Pulmonary Medical Group a Medical Corporation
• Bethany Souza
• Correan Spano
• Jaime Spano, SLP
• Adjana Sparkes
• Minju Sparks, NP-C
• Todd Sparks, DPT

• Family Medicine Physician in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.
• 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.