Active NPI
Pacific Paradise Emergency Physicians Medical Group Inc
- Emergency Medicine Physician
- National City, CA
National Provider Identifier
1780066076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- Legal business name
- PACIFIC PARADISE EMERGENCY PHYSICIANS MEDICAL GROUP INC
- Practice address
- 2400 E 4TH St
National City, CA 91950-2026 - Phone
- (619) 470-4141
- NPI assigned
- Jun 23, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Paul J. Manos, D.O.
- Title
- President
- Phone
- (626) 447-0296
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | Primary |
Addresses
Primary practice location
2400 E 4TH St
National City, CA 91950-2026
Mailing address
PO Box 509015
Department # Ws248
San Diego, CA 92150-9015
Phone (626) 447-0296
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780066076 | Other | CA | MEDI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150820010904 | CA | Part B Supplier - Clinic/Group Practice | 8628383544 |
Receives reassigned benefits from 40 practitioners Practice locations: National City, CA |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 40
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435017600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1466985600000",
"number": "1780066076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 509015",
"address_2": "DEPARTMENT # WS248",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921509015",
"telephone_number": "626-447-0296",
"fax_number": "626-447-6057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 E 4TH ST",
"city": "NATIONAL CITY",
"state": "CA",
"postal_code": "919502026",
"telephone_number": "619-470-4141"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PACIFIC PARADISE EMERGENCY PHYSICIANS MEDICAL GROUP INC",
"organizational_subpart": "NO",
"enumeration_date": "2015-06-23",
"last_updated": "2016-06-27",
"status": "A",
"authorized_official_last_name": "MANOS",
"authorized_official_first_name": "PAUL",
"authorized_official_middle_name": "J.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "626-447-0296",
"authorized_official_credential": "D.O."
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "1780066076",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in National City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.