South Bay Geriatric and Internal Medicine Inc

Primary specialty

Legal MedicineTaxonomy code 173000000X

License

A72963 Issued in CA

Legal business name

SOUTH BAY GERIATRIC AND INTERNAL MEDICINE INC

Practice address

340 4TH Ave
#9
Chula Vista, CA 91910-3813

Phone

(619) 426-9731

Fax

(619) 426-9733

NPI assigned

Jan 31, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Mushrik Kaisey, MDNPI 1386654010

Title

President

Phone

(619) 426-9731

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JJFCBA

Practitioners 5

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

• Mushrik Kaisey, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Chula Vista, CA
  • NPI 1386654010
  Medicare reassignment NPD Authorized official
• Kasey Cheyenne Bamel, DNP

  • Family Nurse Practitioner
  • La Jolla, CA
  • NPI 1487106886
  Medicare reassignment NPD
• Ali Fadhil, M.D.

  • Internal Medicine Physician
  • Chula Vista, CA
  • NPI 1407110109
  Medicare reassignment NPD
• Lucia Fajardo, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Santee, CA
  • NPI 1255864849
  Medicare reassignment NPD
• Danica-Ella M Pantoja, FNP-BC

  • Family Nurse Practitioner
  • San Diego, CA
  • NPI 1457860074
  Medicare reassignment NPD

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

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312243200000",
    "number": "1801192497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 92191",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921910723",
            "telephone_number": "619-426-9731",
            "fax_number": "619-426-9733"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 4TH AVE",
            "address_2": "#9",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919103813",
            "telephone_number": "619-426-9731",
            "fax_number": "619-426-9733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY GERIATRIC AND INTERNAL MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-31",
        "last_updated": "2011-08-02",
        "status": "A",
        "authorized_official_last_name": "KAISEY",
        "authorized_official_first_name": "MUSHRIK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-426-9731",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": "CA",
            "license": "A72963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A729631",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Bay Community Services
• South Bay Community Services
• South Bay Endodontics
• South Bay Family Medical Group, Inc
• South Bay Foot & Ankle Specialists, Inc.
• South Bay Hearing & Balance
• South Bay Internal Medical GRP Inc
• South Bay Internal Medicine and Family Practice Group Inc
• South Bay Mediquipment Inc
• South Bay OBGYN

• Legal Medicine in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Legal Medicine in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; 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.