NPIMap

Jeremy Dane Sporrong, D.O.

Individual provider Active NPI Family Medicine Physician · Loma Linda, CA

NPI 1639439656 · NPPES record last updated Aug 18, 2015

Key facts

NPI
1639439656
Entity type
Individual (NPI type 1)
Primary specialty
Family Medicine Physician 207Q00000X
License
20A13251 (CA)
Practice address
11234 Anderson St
Gme Office CSP 21005
Loma Linda, CA 92354-2804
Phone
(909) 558-6688
NPI assigned
May 23, 2012
Sex
Male
Sole proprietor
No

Organizations & group practices 39

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.

View all 39

Medicare Care Compare profile

Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nevada Health Centers Inc (39 clinicians)

Practice addresses (Care Compare)

1799 Mount Mariah Dr
Las Vegas, NV 89106-1501
Phone (702) 636-5454

3900 Cambridge St
Las Vegas, NV 89119-7440
Phone (702) 307-5415

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20150922001109 CA Practitioner - Family Practice 3577870609 Reassigns benefits to 3 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
13251CAMDProfessional Counselor
20A13251CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Samuel Dixon Family Health Center, Inc Current
since Nov 5, 2016		 Accepting new patients
Northeast Valley Health Corporation Current
since Dec 6, 2016		 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Northeast Valley Health Corporation Current Accepting new patients
Family Health Centers of San Diego, Inc Current
since Aug 24, 2015		 Accepting new patients
Nevada Health Centers, Inc Current
since Feb 10, 2020		 Accepting new patients
Northeast Valley Health Corporation Current
since Dec 6, 2016		 Accepting new patients
Family Health Centers of San Diego, Inc Current
since Aug 24, 2015		 Accepting new patients
Nevada Health Centers, Inc Family Medicine Current Accepting new patients
Nevada Health Centers Inc Current
since Feb 10, 2020		 Accepting new patients
Dignity Health Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
North Vista Hospital LLC Past Accepting new patients
Henderson Hospital Past Accepting new patients
Summerlin Hospital Medical Center L L C Past Accepting new patients
Nevada Health Centers Inc Past Accepting new patients
De Craig Ranch, LLC Past Accepting new patients
Southern Hills Medical Center, LLC Past Accepting new patients

Locations

27225 Camp Plenty Rd
Ste 4
Canyon Country, CA 91351
Phone (661) 252-4100

7843 Lankershim Blvd
North Hollywood, CA 91605
Phone (818) 765-8656

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

1600 San Fernando Rd
San Fernando, CA 91340
Phone (818) 365-8086

1172 N Maclay Ave
San Fernando, CA 91340
Phone (818) 898-1388

30257 San Martinez Rd
Val Verde, CA 91384
Phone (661) 257-4008

25115 Avenue Stanford
#A104
Valencia, CA 91355
Phone (661) 257-2339

1690 E Amargosa Farm Rd
Amargosa Valley, NV 89020
Phone (775) 372-5432

3325 Research Way
Carson City, NV 89706
Phone (775) 887-5140

618 W Musser St
Carson City, NV 89703
Phone (775) 445-3500

762 14th St
Elko, NV 89801
Phone (775) 738-5850

1799 Mount Mariah Dr
Las Vegas, NV 89106
Phone (702) 383-1961

3900 Cambridge St
Ste 102
Las Vegas, NV 89119
Phone (702) 307-5415

2225 Civic Center Dr
Ste 224
North Las Vegas, NV 89030
Phone (702) 214-5948

Interoperability endpoints

  • Direct secure messaging: jsporrong695173@direct.ochin.org
  • FHIR API: https://api.platform.athenahealth.com/1566/brand/2/csg/41/fhir/r4
  • Direct secure messaging: jeremy.sporrong.p1@direct.nevadahealthcenters.nextgenshare.com
  • Direct secure messaging: jeremy.sporrong.1@16501.direct.athenahealth.com

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X 20A13251 CA Yes

Addresses

Primary practice location

11234 Anderson St
Gme Office CSP 21005
Loma Linda, CA 92354-2804

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 906-4623

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 18, 2015.

{
    "created_epoch": "1337731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439856000000",
    "number": "1639439656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-906-4623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11234 ANDERSON ST",
            "address_2": "GME OFFICE CSP 21005",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923542804",
            "telephone_number": "909-558-6688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPORRONG",
        "first_name": "JEREMY",
        "middle_name": "DANE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-23",
        "last_updated": "2015-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A13251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

All providers in Loma Linda, CA · Family Medicine Physician in California

Sources for this page

Verify at the official NPI Registry.