Organization Active NPI

San Diego Shoulder to Fingertips Medical Group Inc

  • Orthopaedic Surgery Physician
  • San Marcos, CA
National Provider Identifier
1639980659
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
SAN DIEGO SHOULDER TO FINGERTIPS MEDICAL GROUP INC
Practice address
277 Rancheros Dr Ste 101
San Marcos, CA 92069-2976
Phone
(760) 750-1902
Fax
(760) 750-1906
NPI assigned
Jan 17, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

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

Authorized official

Name
Brooke Laura Ballard, MDNPI 1841447950
Title
Owner
Phone
(760) 750-1902

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X Primary

Addresses

Primary practice location

277 Rancheros Dr Ste 101
San Marcos, CA 92069-2976

Mailing address

277 Rancheros Dr Ste 101
San Marcos, CA 92069-2976
Phone (760) 750-1902

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250303000630 CA Part B Supplier - Clinic/Group Practice 8224559679 Receives reassigned benefits from 1 practitioner
Practice locations: San Marcos, CA

National Provider Directory

National Provider Directory

Locations

277 Rancheros Dr
Ste 101
San Marcos, CA 92069
Phone (760) 420-2331

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1737072000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1738108800000",
    "number": "1639980659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 RANCHEROS DR STE 101",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692976",
            "telephone_number": "760-750-1902",
            "fax_number": "760-750-1906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "277 RANCHEROS DR STE 101",
            "city": "SAN MARCOS",
            "state": "CA",
            "postal_code": "920692976",
            "telephone_number": "760-750-1902",
            "fax_number": "760-750-1906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO SHOULDER TO FINGERTIPS MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-17",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A",
        "authorized_official_last_name": "BALLARD",
        "authorized_official_first_name": "BROOKE",
        "authorized_official_middle_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "760-750-1902",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Marcos, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.