Newport Children's Medical Group

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

NEWPORT CHILDREN'S MEDICAL GROUP

Practice address

1401 Avocado Ave
#802
Newport Beach, CA 92660-7720

Phone

(949) 644-0970

Fax

(949) 644-0774

NPI assigned

Dec 29, 2005

Organization subpart

No

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

Authorized official

Name

Deron Gilliard, CMPE

Title

Health Administrator

Phone

(949) 644-0970

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 9

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

• Kristine Brown, M.D.

  • Pediatrics Physician
  • Newport Beach, CA
  • NPI 1104820547
  NPD (past)
• Eleanor Man-Ying Chang, M.D.

  • Pediatric Hospice and Palliative Medicine Physician
  • Santa Ana, CA
  • NPI 1619198447
  NPD (past)
• Sandra Kellum, M.D.

  • Pediatrics Physician
  • Newport Beach, CA
  • NPI 1669881397
  NPD (past)
• Asha Misra, MD

  • Pediatrics Physician
  • Newport Beach, CA
  • NPI 1376538595
  NPD (past)
• Mitali Chumki Mitra, M.D.

  • Pediatrics Physician
  • La Mesa, CA
  • NPI 1598049702
  NPD (past)
• Anh DO Rebhan, DO

  • Pediatrics Physician
  • Costa Mesa, CA
  • NPI 1720643729
  NPD (past)
• Kristoffer Roxas, MD

  • Pediatrics Physician
  • Costa Mesa, CA
  • NPI 1811553811
  NPD (past)
• Valerie Christine Sheppard, M.D.

  • Pediatrics Physician
  • Costa Mesa, CA
  • NPI 1750524237
  NPD (past)
• Alexander Tu, M.D.

  • Pediatrics Physician
  • Newport Beach, CA
  • NPI 1851598544
  NPD (past)

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1356328330",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE",
            "address_2": "#802",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607720",
            "telephone_number": "949-644-0970",
            "fax_number": "949-644-0774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 AVOCADO AVE",
            "address_2": "#802",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607720",
            "telephone_number": "949-644-0970",
            "fax_number": "949-644-0774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWPORT CHILDREN'S MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "GILLIARD",
        "authorized_official_first_name": "DERON",
        "authorized_official_title_or_position": "HEALTH ADMINISTRATOR",
        "authorized_official_telephone_number": "949-644-0970",
        "authorized_official_credential": "CMPE"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083892",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0083890",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Newport Center Orthopedic, Inc
• Newport Center Pharmacy
• Newport Center Radiology Associates Medical Group Inc (Newport Imaging Center)
• Newport Center Surgical
• Newport Centre Outpatient Surgery Facilities, Inc.
• Newport Chiropractic Center
• Newport Coast Center for Facial Plastic Surgery
• Newport Coast Dermatology
• Newport Coast Outpatient Surgery Center
• Newport Coast Pathology, Inc.

• Primary Care Clinic/Center in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.