NPIMap

Organization Active NPI

Premiercare Anesthesia Fountain Valley Inc

  • Anesthesiology Physician
  • Fountain Valley, CA
National Provider Identifier
1831536531
Registry record updated Dec 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
PREMIERCARE ANESTHESIA FOUNTAIN VALLEY INC
Practice address
17100 Euclid St.
Fountain Valley, CA 97208
Phone
(714) 966-7200
NPI assigned
Jun 4, 2013
Last updated
Dec 12, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2013

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

Authorized official

Name
Kelvin A Nguyen, MDNPI 1699861146
Title
Authorized Representative
Phone
(949) 856-2356

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

17100 Euclid St.
Fountain Valley, CA 97208

Mailing address

PO Box 8457
Pasadena, CA 91109-9110

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140110000426 CA Part B Supplier - Clinic/Group Practice 5698903003 Receives reassigned benefits from 59 practitioners
Practice locations: Corona del Mar, CA; Fountain Valley, CA; Huntington Beach, CA; Irvine, CA; Long Beach, CA; Tustin, CA

National Provider Directory

National Provider Directory

Locations

17011 Beach Blvd
Ste 540
Huntington Beach, CA 92647

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 60

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 60

NPI Registry JSON

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

{
    "created_epoch": "1370304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386806400000",
    "number": "1831536531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8457",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911099110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17100 EUCLID ST.",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "97208",
            "telephone_number": "714-966-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIERCARE ANESTHESIA FOUNTAIN VALLEY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-04",
        "last_updated": "2013-12-12",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "KELVIN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "AUTHORIZED REPRESENTATIVE",
        "authorized_official_telephone_number": "949-856-2356",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; 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.