NPIMap

Organization Active NPI

St, Jude Heritage Medical Group

  • Family Nurse Practitioner
  • Fullerton, CA
National Provider Identifier
1538436274
Registry record updated Nov 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
21377 Issued in CA
Legal business name
ST, JUDE HERITAGE MEDICAL GROUP
Practice address
731 S Highland Ave
Fullerton, CA 92832-2753
Phone
(714) 446-5100
NPI assigned
Nov 23, 2011
Last updated
Nov 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2011

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

Authorized official

Name
Bob O'Neil
Title
VP of Physician Services
Phone
(714) 578-8616

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 21377 CA Primary

Addresses

Primary practice location

731 S Highland Ave
Fullerton, CA 92832-2753

Mailing address

731 S. Highland Ave
Fullerton, CA 92832-2753

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Hospital Oran44 organizations share this tax ID, including this one

Other organizations with this tax ID 43

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

View all 43

Locations

731 S Highland Ave
Fullerton, CA 92832
Phone (714) 446-5100

NPI Registry JSON

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

{
    "created_epoch": "1322006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322006400000",
    "number": "1538436274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "731 S. HIGHLAND AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928322753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "731 S HIGHLAND AVE",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928322753",
            "telephone_number": "714-446-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST, JUDE HERITAGE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-23",
        "last_updated": "2011-11-23",
        "status": "A",
        "authorized_official_last_name": "O'NEIL",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "VP OF PHYSICIAN SERVICES",
        "authorized_official_telephone_number": "714-578-8616"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "21377",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.