Mercy Associated Pediatrics Subspecialists Medical Group, Inc.

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

Legal business name

MERCY ASSOCIATED PEDIATRICS SUBSPECIALISTS MEDICAL GROUP, INC.

Practice address

4077 5TH Ave
San Diego, CA 92103-2105

Phone

(619) 260-7046

NPI assigned

Apr 4, 2007

Last updated

Aug 22, 2020By 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. Riad Mardoum, M.D.NPI 1417050584

Title

Ceo

Phone

(619) 260-7046

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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.

• Riad Mardoum, M.D.

  • Pediatrics Physician
  • San Diego, CA
  • NPI 1417050584
  Authorized official Same address or phone

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1558483172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 33855",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921633855",
            "telephone_number": "619-401-4016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 5TH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "619-260-7046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY ASSOCIATED PEDIATRICS SUBSPECIALISTS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARDOUM",
        "authorized_official_first_name": "RIAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "619-260-7046",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0057900",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sharonna Mercer, PSYD
• Isabelle Merchant
• Kyle Merchant, PHARMD
• Andrew Mercier
• Mercy Air Service, Inc.
• Mercy Health Pharmacy Corporation
• Mercy Healthcare Services, LLC
• Mercy Vascular, a Professional Medical Corporation
• Stephanie Josette Mereday
• Meredith Walton OD, Optometric Corporation (Heights Optometry, The Vision Collective)

• Neonatal-Perinatal Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Neonatal-Perinatal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.