Individual provider Active NPI

Nicole Tatiana Zawada, MD

  • Emergency Medicine Physician
  • Oceanside, CA
National Provider Identifier
1366903486
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A178129 Issued in CA
Practice address
4002 Vista Way
Oceanside, CA 92056-4506
Phone
(760) 724-8411
NPI assigned
Mar 29, 2019
Last updated
Jun 9, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Emergency Medicine Physician 207P00000X A178129 CA Primary

Addresses

Primary practice location

4002 Vista Way
Oceanside, CA 92056-4506

Mailing address

4002 Vista Way
Oceanside, CA 92056-4506

Other practice location 1

750 E Adams St
Syracuse, NY 13210-1834
Phone (315) 464-4363

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220606002800 CA Practitioner - Emergency Medicine 5294113122 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pacific Emergency Providers a Prof CorpGroup PAC ID 1557327608, 24 clinicians

Practice addresses (Care Compare)

4077 5TH Ave
San Diego, CA 92103-2105
Phone (619) 686-3800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.4 of 100Reported as group
Quality
82.48
Improvement activities
40
Cost
76.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A178129CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pacific Emergency Providers, a Prof. Corp. Emergency Medicine CurrentSince Aug 1, 2023 Accepting new patients

Locations

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

4077 5th Ave
#M
San Diego, CA 92103
Phone (619) 260-7000

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1553817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1366903486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4002 VISTA WAY",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4002 VISTA WAY",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920564506",
            "telephone_number": "760-724-8411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "750 E Adams St",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "NY",
            "postal_code": "132101834",
            "country_code": "US",
            "telephone_number": "315-464-4363",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZAWADA",
        "first_name": "NICOLE",
        "middle_name": "TATIANA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-29",
        "last_updated": "2022-06-09",
        "certification_date": "2022-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A178129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, CA

Sources for this page

Verify at the official NPI Registry.