Bristol Park Medical Group, Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BRISTOL PARK MEDICAL GROUP, INC

Practice address

11420 Warner Ave
Fountain Valley, CA 92708-2529

Phone

(714) 549-1300

Fax

(949) 798-4406

NPI assigned

May 28, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mark D Schafer, MDNPI 1417948894

Title

Medical Director

Phone

(714) 665-1661

Specialties & licenses 4

Addresses

Other identifiers 1

Tax ID family

Bristol Park Medical Group Inc3 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.

• Bristol Park Medical Group, Inc

  • Family Medicine Physician
  • Costa Mesa, CA
  • NPI 1043266760
  NPD tax ID
• Bristol Park Medical Group, Inc

  • Family Medicine Physician
  • Irvine, CA
  • NPI 1386691004
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark D Schafer, MD

  • Internal Medicine Physician
  • Tustin, CA
  • NPI 1417948894
  Authorized official Same address or phone

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224028800000",
    "number": "1689621260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2742 DOW AVE",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927807242",
            "telephone_number": "714-665-1600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11420 WARNER AVE",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927082529",
            "telephone_number": "714-549-1300",
            "fax_number": "949-798-4406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL PARK MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-28",
        "last_updated": "2008-10-15",
        "status": "A",
        "authorized_official_last_name": "SCHAFER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "714-665-1661",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0069197",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jourdan Bretoi
• Brian B, Toorani, D.D.S., Inc.
• Brian Lee, DDS, Inc.
• Alecia Bridgefort, BA
• Dustin Lowell Briggs, CST, CSFA
• Elivet Brito Ruiz-Ramos, M.S.
• Prudence Armandine Broadwell, LAC
• Benjamin Edward Brodie, CMT, NMT
• Suzanne Brodsly, LCSW
• Mark A. Bronstein, M.D.

• Family Medicine Physician in Fountain Valley, CA
• Providers in Fountain Valley, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.