NPIMap

Organization Active NPI

San Diego Cardiac Center Medical Group Inc

  • Cardiovascular Disease Physician
  • San Diego, CA
National Provider Identifier
1801980446
Registry record updated Aug 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
B1987012812 Issued in CA
Legal business name
SAN DIEGO CARDIAC CENTER MEDICAL GROUP INC
Practice address
3131 Berger Ave
Ste 200
San Diego, CA 92123-4233
Phone
(858) 244-6800
Fax
(858) 244-6892
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2023

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

Authorized official

Name
Mrs. Janet Hake
Title
Chief Administrative Officer
Phone
(858) 244-6870

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RC0000X B1987012812 CA Primary

Addresses

Primary practice location

3131 Berger Ave
Ste 200
San Diego, CA 92123-4233

Mailing address

3131 Berger Ave
Ste 200
San Diego, CA 92123-4233
Phone (858) 244-6800

Other identifiers 1

IdentifierTypeStateIssuer
GR0021760MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040917000439 CA Part B Supplier - Clinic/Group Practice 8628045986 Receives reassigned benefits from 28 practitioners
Practice locations: San Diego, CA; La Mesa, CA; El Cajon, CA; Chula Vista, CA; La Jolla, CA

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1058225San Diego Cardiac Center Medical Group, Inc3131 Berger Ave Ste 200, San Diego, CA 92123Certificate of waiverAug 30, 2026

National Provider Directory

National Provider Directory

Locations

8851 Center Dr
Ste 305
La Mesa, CA 91942
Phone (619) 442-0234

6402 El Cajon Blvd
Ste 100
San Diego, CA 92115
Phone (619) 582-4490

4910 Directors Pl
Ste 100
San Diego, CA 92121
Phone (415) 600-1151

6280 Jackson Dr
Ste 8
San Diego, CA 92119
Phone (619) 464-1607

Practitioners & affiliated clinicians

Practitioners 39

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

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1801980446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3131 BERGER AVE",
            "address_2": "STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234233",
            "telephone_number": "858-244-6800",
            "fax_number": "858-244-6892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3131 BERGER AVE",
            "address_2": "STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234233",
            "telephone_number": "858-244-6800",
            "fax_number": "858-244-6892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO CARDIAC CENTER MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "HAKE",
        "authorized_official_first_name": "JANET",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "858-244-6870",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "CA",
            "license": "B1987012812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0021760",
            "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 17, 2023; 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.