St Jude Emergency Medical Group Inc
Organization Active NPI Emergency Medicine Physician · Fullerton, CA
NPI 1720190804 · NPPES record last updated Jun 4, 2024
Key facts
- NPI
- 1720190804
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 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
- Organization subpart
- No
Authorized official
- Name
- Donald J. Greco, MD
- Title
- President
- Phone
- (949) 300-9287
Practitioners 89
-
Donald Greco, MD
-
Perry Le Dinh, DO
-
Jai H Ho, MD
-
Mi Song Kim, MD
-
Michael Scott Kulczycki, D.O.
-
Amir Rombod Rahimian, MD, MPH
-
Brian Jisu Shin, PHYSICIAN ASSISTANT
-
Vijay K Wali, MD
-
Kristin Kahale, MD
-
Andrew Russell Krieger, M.D.
-
Mark Louden, MD
-
Soheil Nafeei, M.D.
-
Pauline Phung, D.O.
-
Daniel Ritter, MD
-
Dustin Marinelli, DO
-
Hsu-Hsiang Chang, D.O.
-
Karl Feng, MD
-
Brian D. Fong, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040217001064 | CA | Part B Supplier - Clinic/Group Practice | 8224923479 |
Receives reassigned benefits from 87 practitioners Practice locations: Fullerton, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CR0096 | Other | CA | RR MEDICARE |
| ZZZ22082Z | Other | CA | BLUE SHIELD |
| GR0042730 | Medicaid | CA | |
| GR0042730 | Other | CA | CALOPTIMA |
Other names
- St Jude Emergency Medicine Group Inc
Other providers in Fullerton, CA
- Spring Home Health
- Richard Lynn Spurlock
- Pretty Joy Ssebakijje
- Whitney St Dennis-Knowles
- St Jude Cardiothoracic Surgeons
- St Jude Hospital
- St Jude Hospital Inc
- St Jude Hospital Inc
- St Jude Hospital Yorba Linda
- St Jude Hospital Yorba Linda
All providers in Fullerton, CA · Emergency Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.