Individual provider Active NPI

David Gonzalez, MD

  • Family Medicine Physician
  • San Juan Capistrano, CA
National Provider Identifier
1548526346
Registry record updated Jul 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A123045 Issued in CA
Practice address
31001 Rancho Viejo Rd
Suite 200
San Juan Capistrano, CA 92675
Phone
(949) 661-9611
NPI assigned
Apr 5, 2012
Last updated
Jul 8, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A123045 CA Primary

Addresses

Primary practice location

31001 Rancho Viejo Rd
Suite 200
San Juan Capistrano, CA 92675

Mailing address

17360 Brookhurst St
Attn: MCMF - Credentialing Department
Fountain Valley, CA 92708-3720
Phone (657) 241-3616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140904001202 CA Practitioner - Family Practice 9335367382 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of California, Geffen School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Practice addresses (Care Compare)

31001 Rancho Viejo Rd
Suite 200
San Juan Capistrano, CA 92675-8704
Phone (949) 661-9611

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions38
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A123045CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorialcare Medical Foundation Family Medicine CurrentSince Jul 15, 2014 Accepting new patients
Bristol Park Medical Group, Inc Family Medicine Past Accepting new patients

Locations

722 Baker St
Costa Mesa, CA 92626
Phone (714) 557-6300

17360 Brookhurst St
Fountain Vly, CA 92708
Phone (657) 241-3592

31001 Rancho Viejo Rd
Ste 200
San Juan Capistrano, CA 92675
Phone (949) 661-9600

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: dgonzalez226812@direct.memorialcare.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436313600000",
    "number": "1548526346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17360 BROOKHURST ST",
            "address_2": "ATTN: MCMF - CREDENTIALING DEPARTMENT",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927083720",
            "telephone_number": "657-241-3616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31001 RANCHO VIEJO RD",
            "address_2": "SUITE 200",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "92675",
            "telephone_number": "949-661-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALEZ",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-05",
        "last_updated": "2015-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A123045",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan Capistrano, CA

Sources for this page

Verify at the official NPI Registry.