NPIMap

Organization Active NPI

University of California Irvine

  • Community/Retail Pharmacy
  • Irvine, CA
National Provider Identifier
1518684430
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
UNIVERSITY OF CALIFORNIA IRVINE
Doing business as
UCI Health-Susan Samueli Integrated Health Institute Pharmacy
Practice address
856 Medical Sciences Quad Rooms 2212, 2212a-B 2222
Irvine, CA 92697-0001
Phone
(714) 456-5514
NPI assigned
Oct 21, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

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

Authorized official

Name
Randolph Siwabessy
Title
Chief Financial Officer
Phone
(714) 456-5180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

856 Medical Sciences Quad Rooms 2212, 2212a-B 2222
Irvine, CA 92697-0001

Mailing address

1500 S Douglass Rd, 2ND Floor
RT 183
Anaheim, CA 92806
Phone (714) 509-6266

Other names 1

  • UCI Health-Susan Samueli Integrated Health Institute Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210420000679 CA Part B Supplier - Pharmacy 5395658181 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Irvine, CA; Orange, CA

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
05D2278167Susan Samueli Integrative Health Institute856 Medical Science Quad Ste 2600, Irvine, CA 92697Certificate of waiverMar 12, 2027

National Provider Directory

National Provider Directory
Tax ID family
Regents of the University of California42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1500 S Douglass Rd
Fl 2
Anaheim, CA 92806

856 Medical Sciences Quad
Rm 2212 2212AB 2222
Irvine, CA 92697
Phone (714) 456-5514

NPI Registry JSON

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

{
    "created_epoch": "1666310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1518684430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S DOUGLASS RD, 2ND FLOOR",
            "address_2": "RT 183",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "92806",
            "telephone_number": "714-509-6266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "856 MEDICAL SCIENCES QUAD ROOMS 2212, 2212A-B 2222",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926970001",
            "telephone_number": "714-456-5514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY OF CALIFORNIA IRVINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-21",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "SIWABESSY",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "714-456-5180"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UCI Health-Susan Samueli Integrated Health Institute Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; 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.