Individual provider Active NPI

John Alec Gaite Moral, M.D.

  • Surgery Physician
  • Chula Vista, CA
National Provider Identifier
1720426190
Registry record updated Sep 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
A137454 Issued in CA
Practice address
480 4TH Ave Ste 404
Chula Vista, CA 91910-4413
Phone
(619) 425-7470
Fax
(619) 425-7472
NPI assigned
Jun 7, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X A137454 CA Primary

Addresses

Primary practice location

480 4TH Ave Ste 404
Chula Vista, CA 91910-4413

Mailing address

480 4TH Ave Ste 404
Chula Vista, CA 91910-4413
Phone (619) 425-7470

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220927003230 CA Practitioner - General Surgery 8527444652 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of California, San Diego School of Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
On Call Specialists Medical Group of San Diego IncGroup PAC ID 7911395231, 145 clinicians
Emergency and Acute Care Medical CorporationGroup PAC ID 9537108279, 431 clinicians
South Bay Surgical Associates Medical Group IncGroup PAC ID 7214998061, 3 clinicians

Practice addresses (Care Compare)

435 H St
Chula Vista, CA 91910-4307
Phone (619) 359-6600

865 3Rd Ave
Suite 112
Chula Vista, CA 91911-1300
Phone (619) 425-7470

Hospital & facility affiliations

  • Sharp Chula Vista Medical Center Hospital, Chula Vista, CA, CCN 050222
  • Scripps Mercy Hospital Hospital, San Diego, CA, CCN 050077

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A137454CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Bay Surgical Associates Medical Group Inc. Surgery CurrentSince Sep 1, 2022 Accepting new patients
Emergency and Acute Care Medical Corporation CurrentSince Nov 1, 2022 Accepting new patients
On Call Specialists Medical Group of San Diego, Inc. CurrentSince Jun 1, 2023 Accepting new patients
Sharp Chula Vista Medical Center Past Accepting new patients
Scripps Health Past Accepting new patients

Locations

751 Medical Center Ct
Chula Vista, CA 91911
Phone (619) 482-3639

480 Fourth Ave
Ste 404
Chula Vista, CA 91910
Phone (619) 425-4559

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

865 Third Ave
Ste 112
Chula Vista, CA 91911
Phone (619) 271-7992

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

650 E Devon Ave
Ste 165
Itasca, IL 60143
Phone (630) 285-1040

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 5

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 2

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": "1370563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1720426190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 4TH AVE STE 404",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104413",
            "telephone_number": "619-425-7470",
            "fax_number": "619-425-7472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 4TH AVE STE 404",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919104413",
            "telephone_number": "619-425-7470",
            "fax_number": "619-425-7472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORAL",
        "first_name": "JOHN ALEC",
        "middle_name": "GAITE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-07",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A137454",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.