NPIMap

Organization Active NPI

Regents of the University of California

  • Emergency Medicine Physician
  • San Diego, CA
National Provider Identifier
1780870899
Registry record updated Aug 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
REGENTS OF THE UNIVERSITY OF CALIFORNIA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9001
Phone
(619) 543-6222
NPI assigned
Sep 21, 2007
Last updated
Aug 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2020

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

Authorized official

Name
Theodore C. Chan, M.D.NPI 1477596856
Title
Authorized Official
Phone
(619) 543-6463

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)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9001

Mailing address

File No 54826
Los Angeles, CA 90074-4826
Phone (888) 486-4340

Other identifiers 1

IdentifierTypeStateIssuer
GR0069870MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031117000940 CA Part B Supplier - Clinic/Group Practice 6406760131 Receives reassigned benefits from 221 practitioners
6 other NPIs on this enrollment
Practice locations: San Diego, CA; La Jolla, CA; Encinitas, CA; El Centro, CA

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

9300 Campus Point Dr
#8676
La Jolla, CA 92037

9300 Campus Point Dr
#8819
La Jolla, CA 92037

200 W Arbor Dr
#8819
San Diego, CA 92103
Phone (619) 543-6213

Practitioners & affiliated clinicians

Practitioners 236

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 236

NPI Registry JSON

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

{
    "created_epoch": "1190332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596672000000",
    "number": "1780870899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE NO 54826",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744826",
            "telephone_number": "888-486-4340",
            "fax_number": "562-924-5830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039001",
            "telephone_number": "619-543-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS OF THE UNIVERSITY OF CALIFORNIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-21",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "THEODORE",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "619-543-6463",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0069870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; 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.

Verify at the official NPI Registry.