NPIMap

Organization Active NPI

G O M G a Medical Partnership

  • Adult Reconstructive Orthopaedic Surgery Physician
  • La Mesa, CA
National Provider Identifier
1306938139
Registry record updated May 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
Legal business name
G O M G A MEDICAL PARTNERSHIP
Practice address
5565 Grossmont Center Dr
BLDG. 3 Suite 256
La Mesa, CA 91942-3020
Phone
(619) 462-3131
Fax
(619) 462-1731
NPI assigned
Sep 29, 2006
Last updated
May 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2024

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

Authorized official

Name
Peter B Hanson, MDNPI 1841216603
Title
Partner
Phone
(619) 462-3131

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X Primary

Addresses

Primary practice location

5565 Grossmont Center Dr
BLDG. 3 Suite 256
La Mesa, CA 91942-3020

Mailing address

5565 Grossmont Center Dr
BLDG. 3 Suite 256
La Mesa, CA 91942-3020
Phone (619) 462-3131

Other names 1

  • Grossmont Orthopaedic Medical Group Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070426000624 CA Part B Supplier - Clinic/Group Practice 1153427836 Receives reassigned benefits from 15 practitioners
Practice locations: La Mesa, CA
O20100930081820 CA DME Supplier - Physician - Orthopedic/Orthopedic SurgeryDME Supplier - Physician - General Practice 1153427836 Practice locations: Las Mesa, CA

National Provider Directory

National Provider Directory

Locations

5565 Grossmont Center Dr
Ste 360
La Mesa, CA 91942
Phone (619) 315-0035

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 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715126400000",
    "number": "1306938139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR",
            "address_2": "BLDG. 3 SUITE 256",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423020",
            "telephone_number": "619-462-3131",
            "fax_number": "619-462-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5565 GROSSMONT CENTER DR",
            "address_2": "BLDG. 3 SUITE 256",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423020",
            "telephone_number": "619-462-3131",
            "fax_number": "619-462-1731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G O M G A MEDICAL PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "619-462-3131",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grossmont Orthopaedic Medical Group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; 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.