NPIMap

Organization Active NPI

Pacific Emergency Providers, a Prof. Corp.

  • Emergency Medicine Physician
  • San Diego, CA
National Provider Identifier
1497790539
Registry record updated Jun 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
PACIFIC EMERGENCY PROVIDERS, A PROF. CORP.
Practice address
4077 Fifth Ave
San Diego, CA 92103-2105
Phone
(619) 686-3800
Fax
(619) 260-7050
NPI assigned
Jun 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2023

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

Authorized official

Name
Jon K. Ludwig, M.D.NPI 1669403911
Title
Owner
Phone
(626) 447-0296

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
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X CA Primary

Addresses

Primary practice location

4077 Fifth Ave
San Diego, CA 92103-2105

Mailing address

PO Box 920131
Dallas, TX 75392-0131
Phone (626) 447-0296

Other identifiers 1

IdentifierTypeStateIssuer
GR0098840MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041209000658 CA Part B Supplier - Clinic/Group Practice 1557327608 Receives reassigned benefits from 86 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

444 E Huntington Dr
Ste 300
Arcadia, CA 91006
Phone (626) 447-0269

4077 5th Ave
#M
San Diego, CA 92103
Phone (619) 260-7000

Practitioners 119

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

View all 119

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687132800000",
    "number": "1497790539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 920131",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753920131",
            "telephone_number": "626-447-0296"
        },
        {
            "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": "619-686-3800",
            "fax_number": "619-260-7050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC EMERGENCY PROVIDERS, A PROF. CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A",
        "authorized_official_last_name": "LUDWIG",
        "authorized_official_first_name": "JON",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "626-447-0296",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0098840",
            "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 Jun 19, 2023; 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.