NPIMap

Organization Active NPI

Prospect Foothill Urgent Care

  • Urgent Care Clinic/Center
  • Tustin, CA
National Provider Identifier
1366834756
Registry record updated Mar 26, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
PROSPECT FOOTHILL URGENT CARE
Practice address
14642 Newport Ave Ste 101
Tustin, CA 92780-6058
Phone
(714) 522-2891
NPI assigned
Feb 23, 2015
Organization subpart
Yes
Parent organization
NEW GENESIS MEDICAL ASSOCIATES, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 26, 2015

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

Authorized official

Name
Mitchell W Lew, MDNPI 1427442672
Title
Owner
Phone
(714) 813-5129

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
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

14642 Newport Ave Ste 101
Tustin, CA 92780-6058

Mailing address

PO Box 11466
Santa Ana, CA 92711-1466
Phone (714) 522-2891

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121105000082 CA Part B Supplier - Clinic/Group Practice 4587815337 Receives reassigned benefits from 8 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Anaheim, CA

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
New Genesis Medical Assoc

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1424649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427328000000",
    "number": "1366834756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11466",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927111466",
            "telephone_number": "714-522-2891",
            "fax_number": "714-903-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14642 NEWPORT AVE STE 101",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927806058",
            "telephone_number": "714-522-2891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT FOOTHILL URGENT CARE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEW GENESIS MEDICAL ASSOCIATES, INC.",
        "enumeration_date": "2015-02-23",
        "last_updated": "2015-03-26",
        "status": "A",
        "authorized_official_last_name": "LEW",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-813-5129",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tustin, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2015; 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.