Advanced Pediatric Medical Group Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A46462 Issued in CA

Legal business name

ADVANCED PEDIATRIC MEDICAL GROUP INC

Practice address

5222 Balboa Ave
Suite 42
San Diego, CA 92117-6904

Phone

(858) 268-0702

Fax

(858) 268-0374

NPI assigned

Oct 10, 2006

Last updated

Feb 25, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jay Jalal Sadrieh, M.D.

Title

President and Officer

Phone

(858) 268-0702

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 2

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.

• Ramin Amani, MD

  • Pediatrics Physician
  • Vista, CA
  • NPI 1659366292
  NPD (past)
• Olivia Kealani Robinson Chatham, NP

  • Family Nurse Practitioner
  • Vista, CA
  • NPI 1740772698
  NPD (past)

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361750400000",
    "number": "1558459180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5222 BALBOA AVE",
            "address_2": "SUITE 42",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921176991",
            "telephone_number": "858-268-0702",
            "fax_number": "858-268-0374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5222 BALBOA AVE",
            "address_2": "SUITE 42",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921176904",
            "telephone_number": "858-268-0702",
            "fax_number": "858-268-0374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED PEDIATRIC MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2013-02-25",
        "status": "A",
        "authorized_official_last_name": "SADRIEH",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "JALAL",
        "authorized_official_title_or_position": "PRESIDENT AND OFFICER",
        "authorized_official_telephone_number": "858-268-0702",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A46462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0071320",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in San Diego, CA
• Providers in San Diego, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2013; 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.