Pacific Gastroenterology Endoscopy Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

060000855 Issued in CA

Legal business name

PACIFIC GASTROENTEROLOGY ENDOSCOPY CENTER

Practice address

26421 Crown Valley Pkwy
Suite 140B
Mission Viejo, CA 92691-8564

Phone

(949) 365-8836

NPI assigned

Feb 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Om P Chaurasia, MDNPI 1528136702

Title

President

Phone

(949) 365-8836

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Pacific Gastroenterology Endoscopy CenterCCN 05C0001598

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Om P Chaurasia, MD

  • Gastroenterology Physician
  • Mission Viejo, CA
  • NPI 1528136702
  NPD Authorized official

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1720129893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26421 CROWN VALLEY PKWY",
            "address_2": "SUITE 140B",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918564",
            "telephone_number": "949-365-8836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26421 CROWN VALLEY PKWY",
            "address_2": "SUITE 140B",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926918564",
            "telephone_number": "949-365-8836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC GASTROENTEROLOGY ENDOSCOPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "CHAURASIA",
        "authorized_official_first_name": "OM",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-365-8836",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "060000855",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE FACILITY LICENSE",
            "identifier": "060000855",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS FACILITY ID",
            "identifier": "AS1598",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD FACILITY ID",
            "identifier": "ZZZH3075Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaclyn Otazu, SLPA
• Justin Michael Otomo, L.AC.
• Brandon Neil Owens, LMFT
• Omar Ozgur, M.D.
• Sarah Dawn Pace, MD, MPH
• Pacific Heights Healthcare, Inc
• Pacific Hills Healthcare Inc
• Pacific Hospitalist Associates a Medical Corporation
• Pacific Pediatric Therapy
• Pacific Solstice Integrative Clinic

• All providers in Mission Viejo, CA
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.