Individual provider Active NPI

Mitchell Thomas Fallon, PA-C

  • Physician Assistant
  • Newport Beach, CA
National Provider Identifier
1720366255
Registry record updated Apr 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA21619 Issued in CA
Practice address
520 Superior Ave Ste 300
Newport Beach, CA 92663-3668
Phone
(949) 764-1411
NPI assigned
Aug 2, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA21619 CA Primary

Addresses

Primary practice location

520 Superior Ave Ste 300
Newport Beach, CA 92663-3668

Mailing address

520 Superior Ave Ste 300
Newport Beach, CA 92663-3668
Phone (949) 764-1411

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111007000260 CA Practitioner - Physician Assistant 1850563289 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hoag ClinicGroup PAC ID 3274872064, 447 clinicians

Practice addresses (Care Compare)

1031 Avenida Pico
Suite 204
San Clemente, CA 92673-6352
Phone (949) 829-5533

500 Superior Ave
Suite 270
Newport Beach, CA 92663-3657
Phone (949) 791-3370

Hospital & facility affiliations

  • Hoag Memorial Hospital Presbyterian Hospital, Newport Beach, CA, CCN 050224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA21619CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Oct 1, 2024 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Oct 1, 2024 Accepting new patients
Keith Mark Gross MD Inc Past Accepting new patients

Locations

420 34th St
Bakersfield, CA 93301
Phone (661) 324-4647

1520 San Pablo St
Ste 2000
Los Angeles, CA 90033
Phone (323) 442-5830

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

520 Superior Ave
Ste 300
Newport Beach, CA 92663
Phone (949) 474-5722

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1312243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1720366255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR AVE STE 300",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633668",
            "telephone_number": "949-764-1411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 SUPERIOR AVE STE 300",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926633668",
            "telephone_number": "949-764-1411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FALLON",
        "first_name": "MITCHELL",
        "middle_name": "THOMAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-02",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21619",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newport Beach, CA

Sources for this page

Verify at the official NPI Registry.