Organization Active NPI

Associated Gastroenterology Medical Group

  • Specialist
  • Anaheim, CA
National Provider Identifier
1326044967
Registry record updated Aug 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
ASSOCIATED GASTROENTEROLOGY MEDICAL GROUP
Practice address
1211 W la Palma Ave
Ste 306
Anaheim, CA 92801-2811
Phone
(714) 778-1300
Fax
(714) 778-0303
NPI assigned
Jun 27, 2005
Last updated
Aug 18, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2010

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

Authorized official

Name
Teri Hall
Title
Office Manager
Phone
(714) 778-1300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

1211 W la Palma Ave
Ste 306
Anaheim, CA 92801-2811

Mailing address

1211 W la Palma Ave
Ste 306
Anaheim, CA 92801-2811
Phone (714) 778-1300

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ83646ZMedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050719001264 CA Part B Supplier - Clinic/Group Practice 2365479565 Receives reassigned benefits from 7 practitioners
Practice locations: Anaheim, CA; Pasadena, CA; Tustin, CA

National Provider Directory

National Provider Directory

Locations

1211 W La Palma Ave
Ste 302
Anaheim, CA 92801
Phone (714) 284-0737

2617 E Chapman Ave
Orange, CA 92869
Phone (714) 538-6822

2617 E Chapman Ave
Ste 302
Orange, CA 92869
Phone (714) 633-1823

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 7

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": "1119830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282089600000",
    "number": "1326044967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE",
            "address_2": "STE 306",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012811",
            "telephone_number": "714-778-1300",
            "fax_number": "714-778-0303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 W LA PALMA AVE",
            "address_2": "STE 306",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928012811",
            "telephone_number": "714-778-1300",
            "fax_number": "714-778-0303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATED GASTROENTEROLOGY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-27",
        "last_updated": "2010-08-18",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "TERI",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "714-778-1300"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ83646Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.