NPIMap

Organization Active NPI

Careconnectmd Ca PC

  • Family Medicine Physician
  • Costa Mesa, CA
National Provider Identifier
1366063125
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CARECONNECTMD CA PC
Practice address
3090 Bristol St Ste 200
Costa Mesa, CA 92626-3061
Phone
(888) 789-9585
Fax
(562) 803-4500
NPI assigned
May 4, 2020
Last updated
Aug 24, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Authorized official

Name
Dr. Christine Mlot, MDNPI 1538240239
Title
President
Phone
(888) 789-9585

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3090 Bristol St Ste 200
Costa Mesa, CA 92626-3061

Mailing address

16162 Beach Blvd Ste 100
Huntington Beach, CA 92647-3828
Phone (888) 789-9585

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200715000596 CA Part B Supplier - Clinic/Group Practice 5496178055 Receives reassigned benefits from 203 practitioners
Practice locations: Corona, CA; Costa Mesa, CA; San Bernardino, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 205

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 205

NPI Registry JSON

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

{
    "created_epoch": "1588550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629763200000",
    "number": "1366063125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16162 BEACH BLVD STE 100",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926473828",
            "telephone_number": "888-789-9585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3090 BRISTOL ST STE 200",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926263061",
            "telephone_number": "888-789-9585",
            "fax_number": "562-803-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARECONNECTMD CA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-04",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A",
        "authorized_official_last_name": "MLOT",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-789-9585",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; 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.