NPIMap

Organization Active NPI

BL Anderson Medical Corporation

  • Family Medicine Physician
  • San Diego, CA
National Provider Identifier
1821627639
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BL ANDERSON MEDICAL CORPORATION
Practice address
10890 Thornmint Rd
San Diego, CA 92127-2402
Phone
(619) 407-8545
Fax
(619) 344-0072
NPI assigned
Apr 3, 2020
Last updated
Jan 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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

Authorized official

Name
Brian AndersonNPI 1396788469
Title
MD/Owner
Phone
(909) 645-4023

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

10890 Thornmint Rd
San Diego, CA 92127-2402

Mailing address

10890 Thornmint Rd # 202
San Diego, CA 92127-2402

Other practice location 1

473 E Carnegie Dr.
Ste 200
San Bernardino, CA 92408
Phone (909) 645-4023

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200505000497 CA Part B Supplier - Clinic/Group Practice 5395176473 Receives reassigned benefits from 19 practitioners
Practice locations: Redlands, CA; San Diego, CA
O20220315002461 UT Part B Supplier - Clinic/Group Practice 5395176473 Receives reassigned benefits from 1 practitioner
Practice locations: North Salt Lake, UT

National Provider Directory

National Provider Directory

Locations

10890 Thornmint Rd
Ste 202
San Diego, CA 92127
Phone (855) 745-8400

250 N Redwood Rd
North Salt Lake, UT 84054
Phone (614) 208-9380

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736121600000",
    "number": "1821627639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10890 THORNMINT RD # 202",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921272402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10890 THORNMINT RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921272402",
            "telephone_number": "619-407-8545",
            "fax_number": "619-344-0072"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "473 E Carnegie Dr.",
            "address_2": "Ste 200",
            "address_purpose": "LOCATION",
            "city": "San Bernardino",
            "state": "CA",
            "postal_code": "92408",
            "country_code": "US",
            "telephone_number": "909-645-4023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BL ANDERSON MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-03",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "909-645-4023"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 6, 2025; 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.