Individual provider Active NPI

Brian T Fagan, M.D.

  • Pediatric Cardiology Physician
  • San Diego, CA
National Provider Identifier
1740308550
Registry record updated Nov 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
A82153 Issued in CA
Practice address
3020 Childrens Way
San Diego, CA 92123-4223
Phone
(858) 966-5855
Fax
(858) 571-7903
NPI assigned
Mar 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X A82153 CA Primary

Addresses

Primary practice location

3020 Childrens Way
San Diego, CA 92123-4223

Mailing address

3020 Childrens Way
MC 5003
San Diego, CA 92123-4223
Phone (858) 309-6300

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
I20100125000585 CA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Pediatric Medicine 6305988676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiovascular Disease (Cardiology)Also: Pediatric Medicine
Education
University of California, San Diego School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rady Children'S Hospital San DiegoGroup PAC ID 3971677493, 164 clinicians

Practice addresses (Care Compare)

3010 Childrens Way
San Diego, CA 92123-4223
Phone (858) 576-1700

3020 Children'S Way
San Diego, CA 92123-4223
Phone (858) 576-1700

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rady Children'S Hospital San Diego CurrentSince Jan 1, 2013 Accepting new patients
Rady Children'S Hospital San Diego CurrentSince Jan 1, 2013 Accepting new patients
Chino Medical Group, Inc Past Accepting new patients
Childrens Hospital of Los Angeles Past Accepting new patients
Pacific Pediatric Cardiology Medical Group Inc Pediatric Cardiology PastSince Nov 23, 2009 Accepting new patients
Pih Health Whittier Hospital Past Accepting new patients
Pasadena Hospital Association, LTD. Past Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation Past Accepting new patients
Ahmc Whittier Hospital Medical Center LP Past Accepting new patients

Locations

2125 Citracado Pkwy
Ste 100
Escondido, CA 92029
Phone (760) 739-1543

25170 Hancock Ave
Fl 1
Murrieta, CA 92562

25170 Hancock Ave
Murrieta, CA 92562
Phone (858) 757-3277

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

3020 Childrens Way
#5003
San Diego, CA 92123
Phone (858) 309-6300

Interoperability endpoints

  • Direct secure messaging: bfagan129108@radychildrens.direct-ci.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415318400000",
    "number": "1740308550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "address_2": "MC 5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300",
            "fax_number": "858-309-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-5855",
            "fax_number": "858-571-7903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAGAN",
        "first_name": "BRIAN",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-27",
        "last_updated": "2014-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "A82153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.