NPIMap

Organization Active NPI

Stockton Cardiology Medical Group Complete Heart Care Inc

  • Cardiovascular Disease Physician
  • Stockton, CA
National Provider Identifier
1477591444
Registry record updated Jul 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
STOCKTON CARDIOLOGY MEDICAL GROUP COMPLETE HEART CARE INC
Practice address
415 E Harding Way
Suite D
Stockton, CA 95204-6118
Phone
(209) 944-5750
NPI assigned
Jun 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2019

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

Authorized official

Name
Abbas Chothia, M.D.NPI 1467490441
Title
President
Phone
(209) 944-5750

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
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X Primary

Addresses

Primary practice location

415 E Harding Way
Suite D
Stockton, CA 95204-6118

Mailing address

415 E Harding Way
Suite D
Stockton, CA 95204-6118
Phone (209) 944-5750

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050520001058 CA Part B Supplier - Clinic/Group Practice 8921048257 Receives reassigned benefits from 22 practitioners
Practice locations: Tracy, CA; San Andreas, CA; Manteca, CA; Stockton, CA
O20230720001576 CA Part B Supplier - Intensive Cardiac Rehabilitation 8921048257 Practice locations: Stockton, CA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0609159Stockton Cardiology Medical Group,Inc415 E Harding Way, Suite D, Stockton, CA 95204Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory

Locations

1300 Kurt Dr
Angels Camp, CA 95222
Phone (209) 736-0813

704 Mountain Ranch Rd
Ste 101
San Andreas, CA 95249
Phone (209) 754-1012

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562112000000",
    "number": "1477591444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 E HARDING WAY",
            "address_2": "SUITE D",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046118",
            "telephone_number": "209-944-5750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 E HARDING WAY",
            "address_2": "SUITE D",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046118",
            "telephone_number": "209-944-5750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKTON CARDIOLOGY MEDICAL GROUP COMPLETE HEART CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2019-07-03",
        "status": "A",
        "authorized_official_last_name": "CHOTHIA",
        "authorized_official_first_name": "ABBAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-944-5750",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; 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.