Individual provider Active NPI

Maily Tara Creamer, D.O.

  • Internal Medicine Physician
  • Newport Beach, CA
National Provider Identifier
1417164450
Registry record updated Jun 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
20A9324 Issued in CA
Practice address
510 Superior Ave
Ste 200B
Newport Beach, CA 92663-3663
Phone
(949) 791-3001
Fax
(949) 791-3096
NPI assigned
May 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2013

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 20A9324 CA Primary
Internal Medicine Physician 207R00000X OS11017 FL
Pediatrics Physician 208000000X 20A9324 CA
Pediatrics Physician 208000000X OS11017 FL

Addresses

Primary practice location

510 Superior Ave
Ste 200B
Newport Beach, CA 92663-3663

Mailing address

510 Superior Ave
Ste 200B
Newport Beach, CA 92663-3663
Phone (949) 791-3001

Other identifiers 2

IdentifierTypeStateIssuer
002548900MedicaidFL
1494AOtherFLBCBSFL

Other names 1

  • Dr. Maily Tara Nguyen Former name

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
I20081222000231 CA Practitioner - Internal Medicine 6800958133 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Western University of Health Sciences College of Dental Med, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hoag ClinicGroup PAC ID 3274872064, 447 clinicians

Practice addresses (Care Compare)

510 Superior Ave
Suite 200D
Newport Beach, CA 92663-3664
Phone (949) 791-3001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS11017FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hoag Clinic CurrentSince Mar 1, 2019 Accepting new patients
Providence Medical Foundation CurrentSince Mar 1, 2014 Accepting new patients
Providence Medical Foundation Current Accepting new patients
Fort Walton Beach Medical Center, Inc. Past Accepting new patients
Hoag Hospital Past Accepting new patients

Locations

510 Superior Ave
Ste 200D
Newport Beach, CA 92663
Phone (949) 791-3003

510 Superior Ave
Ste 200B
Newport Beach, CA 92663
Phone (800) 400-4624

510 Superior Ave
Ste 290
Newport Beach, CA 92663
Phone (949) 764-4500

1031 Avenida Pico
Ste 204
San Clemente, CA 92673
Phone (949) 829-5533

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10944/brand/3/csg/1/fhir/r4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 6

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

Hospital & facility affiliations 2

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": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372204800000",
    "number": "1417164450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 SUPERIOR AVE",
            "address_2": "STE 200B",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633663",
            "telephone_number": "949-791-3001",
            "fax_number": "949-791-3096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 SUPERIOR AVE",
            "address_2": "STE 200B",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633663",
            "telephone_number": "949-791-3001",
            "fax_number": "949-791-3096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CREAMER",
        "first_name": "MAILY",
        "middle_name": "TARA",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-17",
        "last_updated": "2013-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A9324",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "OS11017",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "20A9324",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "OS11017",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002548900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "1494A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAILY",
            "last_name": "NGUYEN",
            "middle_name": "TARA",
            "prefix": "DR.",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.