NPIMap

Organization Active NPI

St Jude Emergency Medical Group Inc

  • Emergency Medicine Physician
  • Fullerton, CA
National Provider Identifier
1720190804
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
ST JUDE EMERGENCY MEDICAL GROUP INC
Practice address
101 E Valencia Mesa Dr
Em Dept
Fullerton, CA 92835-3809
Phone
(949) 300-9287
NPI assigned
Aug 31, 2006
Last updated
Jun 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Authorized official

Name
Donald J. Greco, MDNPI 1922032739
Title
President
Phone
(949) 300-9287

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
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

101 E Valencia Mesa Dr
Em Dept
Fullerton, CA 92835-3809

Mailing address

PO Box 80380
City of Industry, CA 91716-8380
Phone (844) 488-7184

Other names 1

  • St Jude Emergency Medicine Group Inc Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040217001064 CA Part B Supplier - Clinic/Group Practice 8224923479 Receives reassigned benefits from 87 practitioners
Practice locations: Fullerton, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 89

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.

View all 89

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1720190804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 80380",
            "city": "CITY OF INDUSTRY",
            "state": "CA",
            "postal_code": "917168380",
            "telephone_number": "844-488-7184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 E VALENCIA MESA DR",
            "address_2": "EM DEPT",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353809",
            "telephone_number": "949-300-9287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JUDE EMERGENCY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "GRECO",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-300-9287",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Jude Emergency Medicine Group Inc",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "St Jude Emergency Medicine Group Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fullerton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 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.