NPIMap

Organization Active NPI

Alex J. Mercandetti, M.D., Inc. a Professional Corporation

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1831126317
Registry record updated Jan 5, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G41199 Issued in CA
Legal business name
ALEX J. MERCANDETTI, M.D., INC. A PROFESSIONAL CORPORATION
Practice address
4060 Fourth Ave
Suite 335
San Diego, CA 92103-2116
Phone
(619) 291-9285
Fax
(619) 291-9289
NPI assigned
Jun 28, 2006
Last updated
Jan 5, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2016

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

Authorized official

Name
Alex J. Mercandetti, M.D.NPI 1588691455
Title
President
Phone
(619) 291-9285

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G41199 CA Primary

Addresses

Primary practice location

4060 Fourth Ave
Suite 335
San Diego, CA 92103-2116

Mailing address

4060 Fourth Ave
Suite 335
San Diego, CA 92103-2116
Phone (619) 291-9285

Other identifiers 1

IdentifierTypeStateIssuer
GR0084400MedicaidCA

National Provider Directory

National Provider Directory

Locations

3965 5th Ave
Ste 430
San Diego, CA 92103
Phone (619) 291-9285

4060 4th Ave
Ste 335
San Diego, CA 92103
Phone (619) 291-9285

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451952000000",
    "number": "1831126317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVE",
            "address_2": "SUITE 335",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032116",
            "telephone_number": "619-291-9285",
            "fax_number": "619-291-9289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 FOURTH AVE",
            "address_2": "SUITE 335",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032116",
            "telephone_number": "619-291-9285",
            "fax_number": "619-291-9289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEX J. MERCANDETTI, M.D., INC. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2016-01-05",
        "status": "A",
        "authorized_official_last_name": "MERCANDETTI",
        "authorized_official_first_name": "ALEX",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "619-291-9285",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G41199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0084400",
            "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 Jan 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.