NPIMap

Organization Active NPI

Children's Specialists of San Diego - Div of CVS

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • San Diego, CA
National Provider Identifier
1700943313
Registry record updated Apr 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
CHILDREN'S SPECIALISTS OF SAN DIEGO - DIV OF CVS
Practice address
3030 Childrens Way
Suite 202
San Diego, CA 92123-4232
Phone
(858) 966-8030
NPI assigned
Jan 2, 2007
Organization subpart
Yes
Parent organization
CHILDREN'S SPECIALISTS OF SAN DIEGOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 22, 2008

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

Authorized official

Name
Herbert C. Kimmons Jr., M.D.NPI 1023189784
Title
President
Phone
(858) 966-8567

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

3030 Childrens Way
Suite 202
San Diego, CA 92123-4232

Mailing address

3860 Calle Fortunada
Suite 210
San Diego, CA 92123-4800
Phone (858) 309-6303

Other identifiers 1

IdentifierTypeStateIssuer
GR006886KMedicaidCA

Other names 1

  • Children's Associated Medical Group Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Childrens Specialist of San24 organizations share this tax ID, including this one
Part of
Childrens Specialist of San

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

Locations

3030 Childrens Way
Ste 202
San Diego, CA 92123
Phone (858) 966-8030

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208822400000",
    "number": "1700943313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 CALLE FORTUNADA",
            "address_2": "SUITE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234800",
            "telephone_number": "858-309-6303",
            "fax_number": "858-309-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 CHILDRENS WAY",
            "address_2": "SUITE 202",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234232",
            "telephone_number": "858-966-8030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S SPECIALISTS OF SAN DIEGO - DIV OF CVS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHILDREN'S SPECIALISTS OF SAN DIEGO",
        "enumeration_date": "2007-01-02",
        "last_updated": "2008-04-22",
        "status": "A",
        "authorized_official_last_name": "KIMMONS",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-966-8567",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR006886K",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Associated Medical Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Apr 22, 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.