NPIMap

Organization Active NPI

Pac Neuro Inc

  • Neurological Surgery Physician
  • San Diego, CA
National Provider Identifier
1700821915
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
Legal business name
PAC NEURO INC
Practice address
3590 Camino del Rio No.
Suite# 200
San Diego, CA 92108-1716
Phone
(619) 810-1010
Fax
(619) 810-1011
NPI assigned
Jun 19, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Sanjay Ghosh, M.D.
Title
President
Phone
(619) 810-1010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X CA Primary

Addresses

Primary practice location

3590 Camino del Rio No.
Suite# 200
San Diego, CA 92108-1716

Mailing address

3590 Camino del Rio No.
Suite# 200
San Diego, CA 92108-1716
Phone (619) 810-1010

Other practice location 1

6645 Alvarado Rd
Suite# 4000
San Diego, CA 92120-5208
Phone (619) 229-3105

Other identifiers 1

IdentifierTypeStateIssuer
00A625630MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060327000917 CA Part B Supplier - Clinic/Group Practice 1951319383 Receives reassigned benefits from 11 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1700821915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3590 CAMINO DEL RIO NO.",
            "address_2": "SUITE# 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081716",
            "telephone_number": "619-810-1010",
            "fax_number": "619-810-1011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3590 CAMINO DEL RIO NO.",
            "address_2": "SUITE# 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081716",
            "telephone_number": "619-810-1010",
            "fax_number": "619-810-1011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6645 Alvarado Rd",
            "address_2": "SUITE# 4000",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921205208",
            "country_code": "US",
            "telephone_number": "619-229-3105",
            "fax_number": "619-229-3127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PAC NEURO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2022-07-21",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "GHOSH",
        "authorized_official_first_name": "SANJAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-810-1010",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A625630",
            "state": "CA"
        }
    ],
    "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 Jul 21, 2022; 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.