NPIMap

Organization Active NPI

Trauma Team Medical Group Incorporated

  • Emergency Medicine Physician
  • San Diego, CA
National Provider Identifier
1417907510
Registry record updated Feb 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
TRAUMA TEAM MEDICAL GROUP INCORPORATED
Practice address
4077 Fifth Ave
San Diego, CA 92103-2105
Phone
(619) 294-8111
NPI assigned
May 11, 2006
Last updated
Feb 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2024

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

Authorized official

Name
Vishal Bansal, M.D.NPI 1194889410
Title
President
Phone
(619) 298-3100

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
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

4077 Fifth Ave
San Diego, CA 92103-2105

Mailing address

550 Washington St Ste 641
San Diego, CA 92103-2229
Phone (619) 298-3100

Other identifiers 1

IdentifierTypeStateIssuer
1417907510MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081202000088 CA Part B Supplier - Clinic/Group Practice 6002977642 Receives reassigned benefits from 14 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1417907510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 WASHINGTON ST STE 641",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032229",
            "telephone_number": "619-298-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "619-294-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAUMA TEAM MEDICAL GROUP INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "BANSAL",
        "authorized_official_first_name": "VISHAL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-298-3100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1417907510",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Feb 6, 2024; 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.