Balboa Park Internal Medicine, Medical Associates Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

A54031 Issued in CA

Legal business name

BALBOA PARK INTERNAL MEDICINE, MEDICAL ASSOCIATES INC

Practice address

2970 5TH Ave
Suite #140
San Diego, CA 92103-5929

Phone

(619) 260-3456

NPI assigned

Jan 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Gary Woodall, M.D.NPI 1427168301

Title

President

Phone

(619) 260-3456

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

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

• Gary Neal Woodall, M.D.

  • Internal Medicine Physician
  • San Diego, CA
  • NPI 1427168301
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303862400000",
    "number": "1679620868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2970 5TH AVE",
            "address_2": "SUITE #140",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921035929",
            "telephone_number": "619-260-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2970 5TH AVE",
            "address_2": "SUITE #140",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921035929",
            "telephone_number": "619-260-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALBOA PARK INTERNAL MEDICINE, MEDICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2011-04-27",
        "status": "A",
        "authorized_official_last_name": "WOODALL",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-260-3456",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A54031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Balboa Healthcare, Inc.
• Balboa Hospital
• Balboa Nephrology Associates
• Balboa Nephrology Medical Group, Inc.
• Balboa Nephrology Medical Group,Inc.
• Balboa Surgical Institute, Inc.
• Balboa Therapy Center
• Balboa Therapy Group, Inc.
• Kristin Balboa, OTR/L
• Alanna Brooke Balboni, MD

• Specialist in San Diego, CA
• Providers in San Diego, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2011; 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.