NPIMap

Organization Active NPI

South Coast Gynecologic Oncology, Inc

  • Specialist
  • San Diego, CA
National Provider Identifier
1881639946
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A65396 Issued in CA
Legal business name
SOUTH COAST GYNECOLOGIC ONCOLOGY, INC
Practice address
9095 Rio San Diego Dr Ste 425
San Diego, CA 92108-1679
Phone
(858) 455-5524
Fax
(858) 587-9377
NPI assigned
Jun 20, 2006
Last updated
Mar 28, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

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

Authorized official

Name
Annmarie Carlisle
Title
Practice Administrator
Phone
(858) 455-5524

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X G66287 CA
Specialist 174400000X A65396 CA Primary

Addresses

Primary practice location

9095 Rio San Diego Dr Ste 425
San Diego, CA 92108-1679

Mailing address

9095 Rio San Diego Dr Ste 425
San Diego, CA 92108-1679
Phone (858) 455-5524

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060926000346 CA Part B Supplier - Clinic/Group Practice 1557366556 Receives reassigned benefits from 11 practitioners
Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

3390 Carmel Mountain Rd
Ste 130
San Diego, CA 92121
Phone (858) 455-5524

5030 Camino de la Siesta
Ste 202
San Diego, CA 92108

9095 Rio San Diego Dr
Ste 425
San Diego, CA 92108
Phone (858) 455-5524

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 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743120000000",
    "number": "1881639946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9095 RIO SAN DIEGO DR STE 425",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081679",
            "telephone_number": "858-455-5524",
            "fax_number": "858-480-3910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9095 RIO SAN DIEGO DR STE 425",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921081679",
            "telephone_number": "858-455-5524",
            "fax_number": "858-587-9377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COAST GYNECOLOGIC ONCOLOGY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "CARLISLE",
        "authorized_official_first_name": "ANNMARIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "858-455-5524"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G66287",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A65396",
            "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 Mar 28, 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.