NPIMap

Individual provider Active NPI

Gustavo Arturo Mondragon, M.D.

  • Cardiovascular Disease Physician
  • Chula Vista, CA
National Provider Identifier
1619080041
Registry record updated Aug 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
A40640 Issued in CA
Practice address
480 Fourth Ave Ste 500
Chula Vista, CA 91910-4414
Phone
(619) 656-5252
Fax
(619) 656-5250
NPI assigned
Aug 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X A40640 CA Primary

Addresses

Primary practice location

480 Fourth Ave Ste 500
Chula Vista, CA 91910-4414

Mailing address

480 Fourth Ave Ste 500
Chula Vista, CA 91910-4414
Phone (619) 656-5252

Other identifiers 1

IdentifierTypeStateIssuer
00A406400MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070510000417 CA Practitioner - Cardiovascular Disease (Cardiology) 6406740463 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)
Education
Other, 1971
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gustavo a Mondragon M D a Medical CorporationGroup PAC ID 2567725658, 2 clinicians

Practice addresses (Care Compare)

480 4TH Ave
Suite 500
Chula Vista, CA 91910-4414

855 3Rd Ave
Suite 2230
Chula Vista, CA 91911-1350
Phone (619) 656-5252

Hospital & facility affiliations

  • Lorian Health Home health agency, San Diego, CA, CCN 058113
  • A Better Solution in Home Care Home health agency, San Diego, CA, CCN 053116
  • Archer Health Inc Home health agency, Carlsbad, CA, CCN 053124
  • Sea Coast Home Health Care Inc Home health agency, San Diego, CA, CCN 559055
  • Advantage Health Systems Home health agency, San Diego, CA, CCN 058355
  • Sharp Chula Vista Medical Center Hospital, Chula Vista, CA, CCN 050222

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A40640CAMDCardiovascular Disease Physician

Practice roles (7 of 8)

OrganizationSpecialtyStatusNew patients
Emergency and Acute Care Medical Corporation CurrentSince Oct 10, 2017 Accepting new patients
Norberto S. Waisman MD. Inc. Cardiovascular Disease CurrentSince May 1, 2018 Accepting new patients
Paradise Valley Hospital Past Accepting new patients
Scripps Health Past Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients
Scripps Health Past Accepting new patients
Sharp Memorial Hospital PastSince Feb 11, 2004 Accepting new patients

Locations

751 Medical Center Ct
Chula Vista, CA 91911
Phone (619) 482-3639

480 Fourth Ave
Ste 500
Chula Vista, CA 91910
Phone (619) 426-5252

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: gustavo.mondragon.1@19038.direct.athenahealth.com

Organizations & group practices 8

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.

Hospital & facility affiliations 6

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629936000000",
    "number": "1619080041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 FOURTH AVE STE 500",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104414",
            "telephone_number": "619-656-5252",
            "fax_number": "619-656-5250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 FOURTH AVE STE 500",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104414",
            "telephone_number": "619-656-5252",
            "fax_number": "619-656-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONDRAGON",
        "first_name": "GUSTAVO",
        "middle_name": "ARTURO",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2021-08-26",
        "certification_date": "2021-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "A40640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A406400",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.