NPIMap

Organization Active NPI

Scripps Mercy Physicians Cardiology Medical Corporation

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1477644474
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
SCRIPPS MERCY PHYSICIANS CARDIOLOGY MEDICAL CORPORATION
Practice address
4077 Fifth Avenue
Scripps Mercy Hospital
San Diego, CA 92103
Phone
(619) 359-6600
Fax
(619) 632-5736
NPI assigned
Sep 27, 2006
Last updated
Mar 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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

Authorized official

Name
Jerrold Glassman, MDNPI 1245326883
Title
President
Phone
(858) 344-3411

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary
Cardiovascular Disease Physician 207RC0000X
Hospitalist Physician 208M00000X

Addresses

Primary practice location

4077 Fifth Avenue
Scripps Mercy Hospital
San Diego, CA 92103

Mailing address

550 Washington St
Suite 841
San Diego, CA 92103-2213
Phone (619) 359-6600

Other identifiers 1

IdentifierTypeStateIssuer
2056037OtherCAMEDICAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050614000789 CA Part B Supplier - Clinic/Group Practice 0143264879 Receives reassigned benefits from 67 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 76

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 76

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646870400000",
    "number": "1477644474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 WASHINGTON ST",
            "address_2": "SUITE 841",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032213",
            "telephone_number": "619-359-6600",
            "fax_number": "619-632-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVENUE",
            "address_2": "SCRIPPS MERCY HOSPITAL",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92103",
            "telephone_number": "619-359-6600",
            "fax_number": "619-632-5736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCRIPPS MERCY PHYSICIANS CARDIOLOGY MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-27",
        "last_updated": "2022-03-10",
        "certification_date": "2022-03-10",
        "status": "A",
        "authorized_official_last_name": "GLASSMAN",
        "authorized_official_first_name": "JERROLD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-344-3411",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "2056037",
            "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 Mar 10, 2022; 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.