Ocean Beach Medical Group

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

G19279 Issued in CA

Legal business name

OCEAN BEACH MEDICAL GROUP

Practice address

1947 Cable St
San Diego, CA 92107-2807

Phone

(619) 223-7164

NPI assigned

Apr 11, 2012

Last updated

Oct 25, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

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

Authorized official

Name

Kenny Heine

Title

Sr Director Ops

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Part of

Medvantx Inc

Locations

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.

• Jeoffry Bruce Gordon, MD

  • Family Medicine Physician
  • San Diego, CA
  • NPI 1649263682
  NPD (past)

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

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351123200000",
    "number": "1699032938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 CABLE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921072807",
            "telephone_number": "619-223-7164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEAN BEACH MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2012-04-11",
        "last_updated": "2012-10-25",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "SR DIRECTOR OPS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "G19279",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Occupational Health Centers of California, a Medical Corporation (Concentra Medical Center)
• Occupational Health Centers of California, a Medical Corporation (Concentra Medical Center)
• Occupational Health Centers of California, a Medical Corporation (Concentra Medical Center)
• Occupational Testing & Evaluation
• Ocd Anxiety Centers California LLC
• Ocean Beach Medical Group
• Ocean Beach Speech
• Ocean Breeze Hospice, Inc.
• Ocean Pacific Companies, LLC (Ocean Pacific Gym and Wellness, LLC)
• Oceanside Healthcare, Inc. (Seaport Home Health)

• Non-Pharmacy Dispensing Site in San Diego, CA
• Providers in San Diego, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2012; 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.