NPIMap

Individual provider Active NPI

Melissa Thepvongsa

  • Physician Assistant
  • Chula Vista, CA
National Provider Identifier
1750964425
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
59540 Issued in CA
Practice address
765 Medical Center CT
Chula Vista, CA 91911-6600
Phone
(619) 616-2100
NPI assigned
Apr 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 59540 CA Primary

Addresses

Primary practice location

765 Medical Center CT
Chula Vista, CA 91911-6600

Mailing address

765 Medical Center CT
Chula Vista, CA 91911-6600
Phone (619) 616-2100

Other practice location 1

1000 Vale Terrace Dr
Vista, CA 92084-5218
Phone (760) 631-5000

Other practice location 2

8788 Jamacha Rd
Spring Valley, CA 91977-4035
Phone (619) 515-2555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211117002559 CA Practitioner - Physician Assistant 6103215827 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

525 E Main St
El Cajon, CA 92020-4007
Phone (619) 515-2498

8788 Jamacha Rd
Spring Valley, CA 91977-4035
Phone (619) 515-2555

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
59540CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego Inc CurrentSince Feb 8, 2022 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Feb 8, 2022 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
North County Health Project Inc Past Accepting new patients

Locations

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

8788 Jamacha Rd
Spring Valley, CA 91977
Phone (619) 515-2380

Interoperability endpoints

  • Direct secure messaging: mthepvongsa377597@direct.ochin.org

Organizations & group practices 6

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": "1619740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1750964425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 MEDICAL CENTER CT",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116600",
            "telephone_number": "619-616-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 MEDICAL CENTER CT",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116600",
            "telephone_number": "619-616-2100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Vale Terrace Dr",
            "address_purpose": "LOCATION",
            "city": "Vista",
            "state": "CA",
            "postal_code": "920845218",
            "country_code": "US",
            "telephone_number": "760-631-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8788 Jamacha Rd",
            "address_purpose": "LOCATION",
            "city": "Spring Valley",
            "state": "CA",
            "postal_code": "919774035",
            "country_code": "US",
            "telephone_number": "619-515-2555",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THEPVONGSA",
        "first_name": "MELISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-30",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "59540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chula Vista, CA

Sources for this page

Verify at the official NPI Registry.