Scripps Ranch Medical Clinic

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

Organization subpart

No

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

Authorized official

Name

Dr. Jack Wasserman, M.D.

Title

Gen PTR/Medical Director

Phone

(858) 271-6962

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

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 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Adrienne Ertl, M.D.

  • Family Medicine Physician
  • San Diego, CA
  • NPI 1427126895
  Medicare reassignment

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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ64795Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scripps Oral Pathology Service, LLC
• Scripps Psychiatric Medical Group
• Scripps Ranch Dental
• Scripps Ranch Family Dentistry
• Scripps Ranch Family Dentistry
• Brittany Scrivens, LMFT
• David Michael Scrivnor
• Beatriz Scroggins
• Calvin Scroggins
• Katie Scroggins, RBT

• Family Medicine Physician in San Diego, CA
• Providers in San Diego, 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 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.