Organization Active NPI

Dorothy E Hairston M D a Professional Corporation

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1700189693
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A78226 Issued in CA
Legal business name
DOROTHY E HAIRSTON M D A PROFESSIONAL CORPORATION
Practice address
10531 4S Commons Dr # 144
San Diego, CA 92127-3517
Phone
(646) 526-5142
NPI assigned
Dec 15, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Authorized official

Name
Dr. Dorothy E Hairston, M.D.NPI 1114973633
Title
Owner
Phone
(619) 472-4690

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
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X A78226 CA Primary

Addresses

Primary practice location

10531 4S Commons Dr # 144
San Diego, CA 92127-3517

Mailing address

10531 4S Commons Dr # 144
San Diego, CA 92127-3517
Phone (646) 526-5142

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110318000509 CA Part B Supplier - Clinic/Group Practice 6901089580 Receives reassigned benefits from 2 practitioners
Practice locations: National City, CA

National Provider Directory

National Provider Directory

Locations

902 Euclid Ave
National City, CA 91950
Phone (619) 791-7700

10531 4S Commons Dr
#144
San Diego, CA 92127
Phone (646) 526-5142

Practitioners & affiliated clinicians

Practitioners 2

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": "1292371200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1700189693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10531 4S COMMONS DR # 144",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921273517",
            "telephone_number": "646-526-5142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10531 4S COMMONS DR # 144",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921273517",
            "telephone_number": "646-526-5142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOROTHY E HAIRSTON M D A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-15",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "HAIRSTON",
        "authorized_official_first_name": "DOROTHY",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-472-4690",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A78226",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; 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.