NPIMap

Organization Active NPI

Senior Doc Id Medical, PC

  • Family Medicine Physician
  • Orange, CA
National Provider Identifier
1407639941
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SENIOR DOC ID MEDICAL, PC
Practice address
2592 N Santiago Blvd
Orange, CA 92867-1862
Phone
(855) 434-7763
Fax
(949) 281-5550
NPI assigned
Aug 17, 2023
Last updated
Aug 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
John M Geiss, DONPI 1053651497
Title
Chief Executive Officer
Phone
(855) 434-7763

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2592 N Santiago Blvd
Orange, CA 92867-1862

Mailing address

2592 N Santiago Blvd
Orange, CA 92867-1862
Phone (855) 434-7763

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240529001032 ID Part B Supplier - Clinic/Group Practice 0840632469 Receives reassigned benefits from 18 practitioners
Practice locations: Nampa, ID

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1692230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1407639941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2592 N SANTIAGO BLVD",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928671862",
            "telephone_number": "855-434-7763",
            "fax_number": "949-281-5550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2592 N SANTIAGO BLVD",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928671862",
            "telephone_number": "855-434-7763",
            "fax_number": "949-281-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR DOC ID MEDICAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-17",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "GEISS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "855-434-7763",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.