NPIMap

Individual provider Active NPI

Shota Gurchumelidze, M.D.

  • Internal Medicine Physician
  • La Mesa, CA
National Provider Identifier
1821284449
Registry record updated Feb 1, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A-101612 Issued in CA
Practice address
8875 La Mesa Blvd Ste C
La Mesa, CA 91942-5434
Phone
(619) 668-8100
Fax
(619) 667-2688
NPI assigned
Sep 18, 2007
Last updated
Feb 1, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A-101612 CA Primary

Addresses

Primary practice location

8875 La Mesa Blvd Ste C
La Mesa, CA 91942-5434

Mailing address

11848 Miro Cir
San Diego, CA 92131-3323
Phone (858) 997-3161

Other names 1

  • Dr. Shota P Gurtch Professional name

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
I20080118000669 CA Practitioner - Internal Medicine 0941381628 Reassigns benefits to 3 organizations
Practice locations: La Mesa, CA; San Diego, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Health PartnersGroup PAC ID 6608280268, 497 clinicians

Practice addresses (Care Compare)

2823 Fresno St
Fresno, CA 93721-1324
Phone (559) 459-6000

8875 La Mesa Blvd
Suite C
La Mesa, CA 91942-5434
Phone (619) 668-8100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.04 of 100Reported as group
Quality
78.62
Promoting interoperability
100
Improvement activities
40
Cost
75.31

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A-101612CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shota Gurtch, M.D., Inc., a Professional Corporation Internal Medicine Current Accepting new patients
Shota Gurtch, M.D., Inc. a Professional Corporation CurrentSince Apr 19, 2022 Accepting new patients
Community Health Partners CurrentSince Mar 1, 2022 Accepting new patients
Emergency and Acute Care Medical Corporation PastSince Jan 14, 2024 Accepting new patients
Community Hospitalist Medical Group Inc. Internal Medicine Past Accepting new patients
Quantum Healthcare Medical Associates Inc. Internal Medicine Past Accepting new patients
Martin C Fineman MD Med Corp Internal Medicine Past Accepting new patients
Tim Gurtch MD, Inc. Past Accepting new patients

Locations

2755 Herndon Ave
Clovis, CA 93611
Phone (559) 323-4000

15 E Audubon Dr
Fresno, CA 93720
Phone (559) 433-8000

2335 E Kashian Ln
Ste 270
Fresno, CA 93701
Phone (559) 445-1251

2823 Fresno St
Fresno, CA 93721
Phone (559) 459-3965

45 E River Park Pl W
Ste 104
Fresno, CA 93720
Phone (559) 320-0550

8875 La Mesa Blvd
Ste C
La Mesa, CA 91942
Phone (619) 660-6003

805 W Acequia Ave
Ste 2D
Visalia, CA 93291
Phone (559) 622-8687

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1190073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1517443200000",
    "number": "1821284449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11848 MIRO CIR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921313323",
            "telephone_number": "858-997-3161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8875 LA MESA BLVD STE C",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919425434",
            "telephone_number": "619-668-8100",
            "fax_number": "619-667-2688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GURCHUMELIDZE",
        "first_name": "SHOTA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-18",
        "last_updated": "2018-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A-101612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHOTA",
            "last_name": "GURTCH",
            "middle_name": "P",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in La Mesa, CA

Sources for this page

Verify at the official NPI Registry.