Retina Consultants San Diego Inc

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

RETINA CONSULTANTS SAN DIEGO INC

Practice address

12630 Monte Vista Rd
Suite 104
Poway, CA 92064-2526

Phone

(858) 451-1911

Fax

(858) 451-0566

NPI assigned

May 12, 2006

Organization subpart

No

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

Authorized official

Name

Jocelin Ing

Title

Practice Administrator

Phone

(858) 500-7815

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Retina Consultants San Diego Inc Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Retina Consultants San Diego Inc

  • Ophthalmology Physician
  • La Jolla, CA
  • NPI 1366493546

  O20040826001499

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Retina Consultants2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Retina Consultants San Diego Inc

  • Ophthalmology Physician
  • La Jolla, CA
  • NPI 1366493546
  NPD tax ID

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Interoperability endpoints

• Direct secure messaging: tlazzarini@rcsd.intellechartdirect.net

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Ammar, MD

  • Retina Specialist (Ophthalmology) Physician
  • Poway, CA
  • NPI 1982099115
  Medicare reassignment Care Compare group NPD
• Anne Marie Hanneken, MD

  • Ophthalmology Physician
  • La Jolla, CA
  • NPI 1699876011
  Medicare reassignment Care Compare group NPD
• Atul Kumar Jain, M.D.

  • Ophthalmology Physician
  • San Diego, CA
  • NPI 1194905711
  Medicare reassignment Care Compare group NPD
• Thomas Adriano McInnes Lazzarini, MD

  • Retina Specialist (Ophthalmology) Physician
  • San Diego, CA
  • NPI 1477088979
  Medicare reassignment Care Compare group NPD
• Nikolas London, M.D.

  • Ophthalmology Physician
  • San Diego, CA
  • NPI 1730418849
  Medicare reassignment Care Compare group NPD
• Lon Scott Poliner, M.D.

  • Ophthalmology Physician
  • Poway, CA
  • NPI 1720038458
  Medicare reassignment NPD

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707177600000",
    "number": "1790736098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12630 MONTE VISTA RD",
            "address_2": "SUITE 104",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642526",
            "telephone_number": "858-451-1911",
            "fax_number": "858-451-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12630 MONTE VISTA RD",
            "address_2": "SUITE 104",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920642526",
            "telephone_number": "858-451-1911",
            "fax_number": "858-451-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA CONSULTANTS SAN DIEGO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2024-02-06",
        "certification_date": "2024-02-06",
        "status": "A",
        "authorized_official_last_name": "ING",
        "authorized_official_first_name": "JOCELIN",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "858-500-7815"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "DA1466",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0045281",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ30299Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Retina Consultants San Diego Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ophthalmology Physician in Poway, CA
• Providers in Poway, CA by specialty
• Ophthalmology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.