Jeffrey Wannares

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

2017-01040 Issued in NC

Practice address

8554 La Mesa Blvd
La Mesa, CA 91942-9558

Phone

(619) 698-4471

NPI assigned

Oct 1, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

General Surgery

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Emergency and Acute Care Medical CorporationGroup PAC ID 9537108279, 431 clinicians

Grossmont Surgical Associates IncGroup PAC ID 3476657313, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Grossmont Hospital Hospital, La Mesa, CA, CCN 050026

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jwannares32419@sharphealthcare.direct-ci.com

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

• Emergency and Acute Care Medical Corporation

  • Emergency Medicine Physician
  • San Diego, CA
  • NPI 1437103942
  Medicare reassignment Care Compare group NPD
• Grossmont Surgical Associates,Inc

  • Surgery Physician
  • La Mesa, CA
  • NPI 1295827830
  Medicare reassignment Care Compare group NPD
• Southern California Surgical Inc

  • Surgery Physician
  • La Mesa, CA
  • NPI 1861014599
  NPD Authorized official
• Grossmont Hospital Corporation

  • General Acute Care Hospital
  • La Mesa, CA
  • NPI 1528041811
  NPD (past)
• Vidant Medical Group LLC

  • Multi-Specialty Clinic/Center
  • Greenville, NC
  • NPI 1477648731
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Grossmont Hospital Corporation

  • General Acute Care Hospital
  • La Mesa, CA
  • NPI 1528041811
  Care Compare affiliation

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

{
    "created_epoch": "1380585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596240000000",
    "number": "1851728141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6415 REFLECTION DR APT 206",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921243167",
            "telephone_number": "508-898-0986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8554 LA MESA BLVD",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919429558",
            "telephone_number": "619-698-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANNARES",
        "first_name": "JEFFREY",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-01",
        "last_updated": "2020-08-01",
        "certification_date": "2020-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "2017-01040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851728141",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NC",
            "identifier": "19RFY",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "NCY8940322",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bradley Kevin Walsh, PT
• Kelly Walsh
• Sheri Lynn Walter, M.D.
• Breanna Walters, MFT TRAINEE
• Joyce Wang, M.D.
• Katherine Ward, APRN, FNP-C
• Shanna Wardhaugh
• Lindsay Marie Warner
• Jeffrey Phillip Wasserstrom, M.D.
• Carol L Watkins, MS, LMFT

• Surgery Physician in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.