NPIMap

Individual provider Active NPI

Tina Nikoomanesh, DO

  • Endocrinology, Diabetes & Metabolism Physician
  • San Diego, CA
National Provider Identifier
1801390042
Registry record updated Jul 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
20A17855 Issued in CA
Practice address
4077 Fifth Ave # Mer35
San Diego, CA 92103-2105
Phone
(619) 294-8111
NPI assigned
Mar 21, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 20A17855 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

4077 Fifth Ave # Mer35
San Diego, CA 92103-2105

Mailing address

4077 Fifth Ave # Mer35
San Diego, CA 92103-2105

Other practice location 1

422 Arneill Rd Ste B
Camarillo, CA 93010-6434
Phone (805) 482-1282

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
I20230209002950 CA Practitioner - Internal MedicinePractitioner - Endocrinology 7012389539 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Endocrinology
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Community Memorial Health SystemGroup PAC ID 9537155676, 187 clinicians

Practice addresses (Care Compare)

422 Arneill Rd B
Camarillo, CA 93010-6434
Phone (805) 383-4510

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
17855CAMDClinical Social Worker
20A17855CAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Community Memorial Health System Current Accepting new patients
Scripps Health Current Accepting new patients
Community Memorial Health System CurrentSince Aug 1, 2023 Accepting new patients
Community Memorial Health System CurrentSince Aug 1, 2023 Accepting new patients
Community Memorial Hospital Past Accepting new patients

Locations

5800 Santa Rosa Rd
Ste 149
Camarillo, CA 93012
Phone (805) 465-8900

422 Arneill Rd
Ste B
Camarillo, CA 93010
Phone (805) 383-4510

2361 E Vineyard Ave
Oxnard, CA 93036
Phone (805) 981-3770

2921 Saviers Rd
Oxnard, CA 93033
Phone (805) 487-5588

4077 5th Ave
#35
San Diego, CA 92103
Phone (619) 260-7220

5855 Olivas Park Dr
Ventura, CA 93003
Phone (805) 652-5469

138 W Main St
Ste E
Ventura, CA 93001
Phone (805) 667-2850

147 N Brent St
Ventura, CA 93003
Phone (805) 652-5011

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: tnikoomanesh3514664@oc.providencedirect.org
  • Direct secure messaging: tnikoomanesh78068@scrippshlth.medalliesdirect.net
  • Direct secure messaging: tinanikoomanesh@cfh.allscriptsdirect.net

Organizations & group practices 5

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 12

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": "1521590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689206400000",
    "number": "1801390042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVE # MER35",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVE # MER35",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "619-294-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "422 Arneill Rd Ste B",
            "address_purpose": "LOCATION",
            "city": "Camarillo",
            "state": "CA",
            "postal_code": "930106434",
            "country_code": "US",
            "telephone_number": "805-482-1282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIKOOMANESH",
        "first_name": "TINA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-21",
        "last_updated": "2023-07-13",
        "certification_date": "2023-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "20A17855",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.