NPIMap

Organization Active NPI

San Diego General and Vascular Surgeons Medical Group, Inc.

  • Surgery Physician
  • San Diego, CA
National Provider Identifier
1407957673
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
SAN DIEGO GENERAL AND VASCULAR SURGEONS MEDICAL GROUP, INC.
Practice address
7910 Frost St Ste 250
San Diego, CA 92123-2752
Phone
(858) 565-0104
Fax
(858) 565-0194
NPI assigned
Sep 26, 2006
Organization subpart
Yes
Parent organization
SAN DIEGO GENERAL AND VASCULAR SURGEONS MEDICAL GROUP, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Yolanda Beltran Lumn, BOM
Title
Administrator
Phone
(858) 565-0104

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

7910 Frost St Ste 250
San Diego, CA 92123-2752

Mailing address

7910 Frost St Ste 250
San Diego, CA 92123-2752
Phone (858) 565-0104

Other names 1

  • San Diego Surgical Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050817001231 CA Part B Supplier - Clinic/Group Practice 4183654247 Receives reassigned benefits from 8 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory
Tax ID family
San Diego Ambulatory Su2 organizations share this tax ID, including this one
Part of
San Diego Ambulatory Su

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

7930 Frost St
Ste 101
San Diego, CA 92123
Phone (858) 492-9977

Practitioners & affiliated clinicians

Practitioners 8

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": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1407957673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7910 FROST ST STE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232752",
            "telephone_number": "858-565-0104",
            "fax_number": "858-565-0194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 FROST ST STE 250",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232752",
            "telephone_number": "858-565-0104",
            "fax_number": "858-565-0194"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO GENERAL AND VASCULAR SURGEONS MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAN DIEGO GENERAL AND VASCULAR SURGEONS MEDICAL GROUP, INC.",
        "enumeration_date": "2006-09-26",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "BELTRAN LUMN",
        "authorized_official_first_name": "YOLANDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "858-565-0104",
        "authorized_official_credential": "BOM"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Diego Surgical Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; 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.