Organization Active NPI

North Coast Family Medical Group

  • General Practice Physician
  • Encinitas, CA
National Provider Identifier
1356569834
Registry record updated Jun 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
G50467 Issued in CA
Legal business name
NORTH COAST FAMILY MEDICAL GROUP
Practice address
477 N. El Camino Real
A306
Encinitas, CA 92024-1350
Phone
(760) 942-0118
Fax
(760) 942-5319
NPI assigned
Apr 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2014

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

Authorized official

Name
Craig S Duck, MDNPI 1306808613
Title
Ceo
Phone
(760) 942-0118

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
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X G50467 CA Primary

Addresses

Primary practice location

477 N. El Camino Real
A306
Encinitas, CA 92024-1350

Mailing address

477 N. El Camino Real
A306
Encinitas, CA 92024-1350
Phone (760) 942-0118

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050112001169 CA Part B Supplier - Clinic/Group Practice 2365491719 Receives reassigned benefits from 17 practitioners
Practice locations: Encinitas, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0566594North Coast Family Medical Group, Inc477 N El Camino Real Ste a 306, Encinitas, CA 92024Provider-performed microscopyAug 6, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1356569834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 N. EL CAMINO REAL",
            "address_2": "A306",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920241350",
            "telephone_number": "760-942-0118",
            "fax_number": "760-942-5319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 N. EL CAMINO REAL",
            "address_2": "A306",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920241350",
            "telephone_number": "760-942-0118",
            "fax_number": "760-942-5319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH COAST FAMILY MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "DUCK",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-942-0118",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "G50467",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Encinitas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.