Individual provider Active NPI

Robert Faillace, AUD, CCC/A

  • Audiologist
  • San Diego, CA
National Provider Identifier
1417971110
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AU1380 Issued in CA
Practice address
3590 Camino del Rio N
Suite# 201
San Diego, CA 92108-1707
Phone
(619) 810-1204
NPI assigned
Jul 26, 2006
Last updated
Dec 3, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AU1380 CA Primary
Audiologist-Hearing Aid Fitter 237600000X AU1380 CA

Addresses

Primary practice location

3590 Camino del Rio N
Suite# 201
San Diego, CA 92108-1707

Mailing address

3590 Camino del Rio N
Suite# 201
San Diego, CA 92108-1707
Phone (619) 810-1204

Other identifiers 2

IdentifierTypeStateIssuer
AU0013800OtherCABLUE SHIELD
AU1380OtherCABLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040811000798 CA Practitioner - Qualified Audiologist 5395717136 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chears IncGroup PAC ID 1153374707, 4 clinicians

Practice addresses (Care Compare)

3590 Camino del Rio N
Suite 201
San Diego, CA 92108-1707
Phone (619) 810-1204

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Arts

State licenses

LicenseStateTypeSpecialty
1380CAMDOccupational Therapist
AU1380CAMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Chears, Inc. Audiologist CurrentSince Oct 1, 2004 Accepting new patients
Hearx West Inc Audiologist-Hearing Aid Fitter Past Accepting new patients
Hearx West, LLC Audiologist-Hearing Aid Fitter Past Accepting new patients

Locations

3590 Camino del Rio N
Ste 201
San Diego, CA 92108
Phone (619) 810-1010

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733184000000",
    "number": "1417971110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3590 CAMINO DEL RIO N",
            "address_2": "SUITE# 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081707",
            "telephone_number": "619-810-1204",
            "fax_number": "619-517-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3590 CAMINO DEL RIO N",
            "address_2": "SUITE# 201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081707",
            "telephone_number": "619-810-1204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAILLACE",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "AUD, CCC/A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "CA",
            "license": "AU1380",
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "CA",
            "license": "AU1380",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "AU0013800",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "AU1380",
            "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 Dec 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.