NPIMap

Organization Active NPI

Ellyn Levine, MD, Inc.

  • Health Service Clinic/Center
  • La Mesa, CA
National Provider Identifier
1386072163
Registry record updated May 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
G86297 Issued in CA
Legal business name
ELLYN LEVINE, MD, INC.
Practice address
5290 Baltimore Dr
La Mesa, CA 91942-2080
Phone
(619) 567-6914
Fax
(619) 567-8228
NPI assigned
Oct 14, 2013
Last updated
May 31, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2016

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

Authorized official

Name
Dr. Ellyn Levine, MDNPI 1760470546
Title
Incorporator
Phone
(858) 663-1671

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
Health Service Clinic/Center 261QH0100X G86297 CA Primary

Addresses

Primary practice location

5290 Baltimore Dr
La Mesa, CA 91942-2080

Mailing address

3830 Valley Centre Dr # 705-306
San Diego, CA 92130-3320
Phone (619) 567-6914

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131226001400 CA Part B Supplier - Clinic/Group Practice 4587891353 Receives reassigned benefits from 1 practitioner
Practice locations: La Mesa, CA

National Provider Directory

National Provider Directory

Locations

5290 Baltimore Dr
La Mesa, CA 91942
Phone (619) 567-6914

5358 Jackson Dr
La Mesa, CA 91942
Phone (619) 567-6914

3830 Valley Centre Dr
Ste 705306
San Diego, CA 92130

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1381708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464652800000",
    "number": "1386072163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3830 VALLEY CENTRE DR # 705-306",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303320",
            "telephone_number": "619-567-6914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5290 BALTIMORE DR",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919422080",
            "telephone_number": "619-567-6914",
            "fax_number": "619-567-8228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLYN LEVINE, MD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-14",
        "last_updated": "2016-05-31",
        "status": "A",
        "authorized_official_last_name": "LEVINE",
        "authorized_official_first_name": "ELLYN",
        "authorized_official_title_or_position": "INCORPORATOR",
        "authorized_official_telephone_number": "858-663-1671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "CA",
            "license": "G86297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2016; 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.