Maryampoursartipmd Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

MARYAMPOURSARTIPMD INC.

Practice address

665 Camino de Los Mares Ste 305
San Clemente, CA 92673-2841

Phone

(949) 371-9259

NPI assigned

Sep 14, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Maryam Poursartip, MDNPI 1225298110

Title

Internal Medicine

Phone

(917) 575-6669

Specialties & licenses 1

Addresses

Other names 1

• 80/20 Quantum Care Doing business as

Practitioners 1

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

• Maryam Poursartip, M.D.

  • Internal Medicine Physician
  • Desert Hot Springs, CA
  • NPI 1225298110
  NPD Authorized official

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

{
    "created_epoch": "1631577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640044800000",
    "number": "1407526270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "258 WHITE CAP LN",
            "city": "NEWPORT COAST",
            "state": "CA",
            "postal_code": "926571088",
            "telephone_number": "917-575-6669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "665 CAMINO DE LOS MARES STE 305",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926732841",
            "telephone_number": "949-371-9259"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "258 White Cap Ln",
            "address_purpose": "LOCATION",
            "city": "Newport Coast",
            "state": "CA",
            "postal_code": "926571088",
            "country_code": "US",
            "telephone_number": "949-371-9259",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARYAMPOURSARTIPMD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-21",
        "status": "A",
        "authorized_official_last_name": "POURSARTIP",
        "authorized_official_first_name": "MARYAM",
        "authorized_official_title_or_position": "INTERNAL MEDICINE",
        "authorized_official_telephone_number": "917-575-6669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "80/20 Quantum Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "80/20 Quantum Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.