Center for Primary Care Medical Group Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

A055299 Issued in CA

Legal business name

CENTER FOR PRIMARY CARE MEDICAL GROUP INC

Practice address

8700 Warner Ave
Suite 140
Fountain Valley, CA 92708-3207

Phone

(714) 847-6727

Fax

(714) 847-6643

NPI assigned

Nov 19, 2007

Organization subpart

No

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

Authorized official

Name

Robert Tae Ha, MDNPI 1750302188

Title

President

Phone

(714) 847-6727

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Tae Ha, MD

  • Internal Medicine Physician
  • Garden Grove, CA
  • NPI 1750302188

  CA, Internal Medicine

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385078400000",
    "number": "1467633362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8700 WARNER AVE",
            "address_2": "SUITE 140",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083207",
            "telephone_number": "714-847-6727",
            "fax_number": "714-847-6643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 WARNER AVE",
            "address_2": "SUITE 140",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083207",
            "telephone_number": "714-847-6727",
            "fax_number": "714-847-6643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PRIMARY CARE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2013-11-22",
        "status": "A",
        "authorized_official_last_name": "HA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "TAE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-847-6727",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A055299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A552992",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Fountain Valley, CA
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2013; 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.