Individual provider Active NPI

Ryan Christopher Fong, PA-C

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1336659218
Registry record updated Sep 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA55027 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(800) 926-8273
Fax
(888) 539-8781
NPI assigned
Oct 5, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA55027 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

File 57326
Los Angeles, CA 90074-7326

Other practice location 1

1505 Encinitas Blvd
Encinitas, CA 92024-2933
Phone (800) 926-8273

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180213002583 CA Practitioner - Physician Assistant 4880954791 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
UC San Diego Health Community GroupGroup PAC ID 3971849175, 109 clinicians

Practice addresses (Care Compare)

16950 Via Tazon
San Diego, CA 92127-1607
Phone (800) 926-8273

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
55027CAMDDentist
PA55027CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lodi Memorial Hospital Association Inc CurrentSince Feb 1, 2018 Accepting new patients
Lodi Memorial Hospital Association Inc CurrentSince Feb 1, 2018 Accepting new patients
Scripps Health Current Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

2415 W Vine St
Ste 105
Lodi, CA 95242
Phone (209) 333-3121

801 S Ham Ln
Ste S
Lodi, CA 95242
Phone (209) 333-8066

975 S Fairmont Ave
Lodi, CA 95240
Phone (209) 339-7575

1901 W Kettleman Ln
Ste 200
Lodi, CA 95242
Phone (209) 334-8540

10790 Rancho Bernardo Rd
#4S205
San Diego, CA 92127
Phone (858) 605-7171

Interoperability endpoints

  • Direct secure messaging: rfong334604@scrippshlth.medalliesdirect.net

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1507161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1336659218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE 57326",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900747326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1505 Encinitas Blvd",
            "address_purpose": "LOCATION",
            "city": "Encinitas",
            "state": "CA",
            "postal_code": "920242933",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "fax_number": "888-539-8781",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONG",
        "first_name": "RYAN",
        "middle_name": "CHRISTOPHER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-05",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA55027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.