NPIMap

Organization Active NPI

Scripps Ranch Medical Clinic

  • Family Medicine Physician
  • San Diego, CA
National Provider Identifier
1285702654
Registry record updated Nov 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SCRIPPS RANCH MEDICAL CLINIC
Practice address
9999 Mira Mesa Blvd Ste 104
San Diego, CA 92131-1006
Phone
(858) 271-6962
Fax
(858) 271-5327
NPI assigned
Dec 1, 2006
Last updated
Nov 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2010

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

Authorized official

Name
Dr. Jack Wasserman, M.D.NPI 1306914783
Title
Gen PTR/Medical Director
Phone
(858) 271-6962

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

9999 Mira Mesa Blvd Ste 104
San Diego, CA 92131-1006

Mailing address

9999 Mira Mesa Blvd Ste 104
San Diego, CA 92131-1006
Phone (858) 271-6962

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050321000699 CA Part B Supplier - Clinic/Group Practice 5193770352 Receives reassigned benefits from 1 practitioner
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1291075200000",
    "number": "1285702654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9999 MIRA MESA BLVD STE 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311006",
            "telephone_number": "858-271-6962",
            "fax_number": "858-271-5327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9999 MIRA MESA BLVD STE 104",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921311006",
            "telephone_number": "858-271-6962",
            "fax_number": "858-271-5327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCRIPPS RANCH MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2010-11-30",
        "status": "A",
        "authorized_official_last_name": "WASSERMAN",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "GEN PTR/MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "858-271-6962",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.