NPIMap

Organization Active NPI

San Diego Hospital Based Physicians Medical Association

  • Emergency Medicine Physician
  • San Diego, CA
National Provider Identifier
1417907882
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SAN DIEGO HOSPITAL BASED PHYSICIANS MEDICAL ASSOCIATION
Practice address
4077 Fifth Ave
San Diego, CA 92103-2105
Phone
(619) 294-8111
NPI assigned
May 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael Sullivan, M.D.
Title
President
Phone
(619) 294-8111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

4077 Fifth Ave
San Diego, CA 92103-2105

Mailing address

PO Box 87729
San Diego, CA 92138-7729
Phone (619) 285-5996

Other identifiers 1

IdentifierTypeStateIssuer
GR0076320MedicaidCA

National Provider Directory

National Provider Directory

Locations

4077 5th Ave
Ste MER127
San Diego, CA 92103

4077 5th Ave
#35
San Diego, CA 92103
Phone (619) 260-7220

Practitioners & affiliated clinicians

Practitioners 9

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": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1417907882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 87729",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921387729",
            "telephone_number": "619-285-5996"
        },
        {
            "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": "SAN DIEGO HOSPITAL BASED PHYSICIANS MEDICAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-294-8111",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0076320",
            "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 Aug 22, 2020; 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.