Lucinda Fan, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0110008048 Issued in VA

Practice address

4060 Fourth Ave Ste 240
San Diego, CA 92103-2120

Phone

(619) 291-6064

NPI assigned

Sep 12, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA, DC, CA3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

George Washington University School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

San Diego Gastroenterology Medical AssociatesGroup PAC ID 8123008935, 10 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

80.52 of 100Reported as group

Quality

56.13

Promoting interoperability

98

Improvement activities

40

Cost

80.61

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• San Diego Gastroenterology Medical Associates

  dba Denison, Goodman, Epsten & Haynes Medical Corporation

  • Gastroenterology Physician
  • San Diego, CA
  • NPI 1578621199
  Medicare reassignment Care Compare group
• Gastroenterology Associates of Northern Virginia, LLC

  • Gastroenterology Physician
  • Fairfax, VA
  • NPI 1205884368

  DC

  Medicare reassignment
• Old Dominion Anesthesia LLC

  • Anesthesiology Physician
  • Charlottesville, VA
  • NPI 1902248677
  NPD (past)

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

{
    "created_epoch": "1631404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1578232534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1320 N VEITCH ST UNIT 1406",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222016208",
            "telephone_number": "909-837-7936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVE STE 240",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032120",
            "telephone_number": "619-291-6064"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3028 Javier Rd Ste 500",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314622",
            "country_code": "US",
            "telephone_number": "703-698-8960",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3028 Javier Rd Ste 300",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314622",
            "country_code": "US",
            "telephone_number": "703-698-8960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FAN",
        "first_name": "LUCINDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-12",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "59936",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110008048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Famly Health Centers of San Diego (North Park Family Health Center Hillcrest Dental)
• Angela Marie Famous
• Christopher Fan
• David Fan, M.D.
• Jian Min Fan, MD , MS OF TCM
• Siuman Fan, D.D.S.
• Stephanie Fan, CRNA
• Stephen Fan, DMD
• Ting-Wei Fan
• Candace Fanale, PHD

• Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.