South Coast Medical Group Family and Sports Medicine

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

SOUTH COAST MEDICAL GROUP FAMILY AND SPORTS MEDICINE

Practice address

5 Journey Ste 130
Aliso Viejo, CA 92656-5330

Phone

(949) 360-1069

Fax

(949) 389-8968

NPI assigned

Jan 2, 2007

Organization subpart

No

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

Authorized official

Name

Johnna Gherardini, BSBA

Title

Executive Director

Phone

(949) 360-1069

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

South Coast Medical Group3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• South Coast Medical Group

  • Primary Care Clinic/Center
  • Aliso Viejo, CA
  • NPI 1487958518
  NPD tax ID
• South Coast Medical Group

  • Primary Care Clinic/Center
  • Aliso Viejo, CA
  • NPI 1821181538
  NPD tax ID

Practitioners 1

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

• Shannon Michele O'Connor, M.D

  • Family Medicine Physician
  • Aliso Viejo, CA
  • NPI 1861586554
  Medicare reassignment NPD

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438214400000",
    "number": "1649337221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 JOURNEY STE 130",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926565330",
            "telephone_number": "949-360-1069",
            "fax_number": "949-389-8968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 JOURNEY STE 130",
            "city": "ALISO VIEJO",
            "state": "CA",
            "postal_code": "926565330",
            "telephone_number": "949-360-1069",
            "fax_number": "949-389-8968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COAST MEDICAL GROUP FAMILY AND SPORTS MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2015-07-30",
        "status": "A",
        "authorized_official_last_name": "GHERARDINI",
        "authorized_official_first_name": "JOHNNA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "949-360-1069",
        "authorized_official_credential": "BSBA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN CHENG, MD",
            "identifier": "1619061397",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARCHANNA BHOGILL, MD",
            "identifier": "1598723058",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SHANNON O'CONNOR, MD",
            "identifier": "1861586554",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ERIC CLARK, MD",
            "identifier": "1932284478",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Khaled Soliman, DMD
• South Coast Dentistry
• South Coast Fertility Lab
• South Coast Medical Group
• South Coast Medical Group
• South County Healthcare
• Southwest Healthcare Management
• Jessica Shannon Spargur, M. A.
• Jeanne Spence
• Nicole E Starkey, DDS

• Primary Care Clinic/Center in Aliso Viejo, CA
• Providers in Aliso Viejo, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; 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.