NPIMap

Individual provider Active NPI

Matthew David Tadlock, MD

  • Surgical Critical Care Physician
  • San Diego, CA
National Provider Identifier
1881666956
Registry record updated Sep 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Critical Care PhysicianTaxonomy code 2086S0102X
License
C54740 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(800) 926-8273
Fax
(619) 532-6299
NPI assigned
Feb 3, 2006
Last updated
Sep 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Aerospace Medicine Physician 2083A0100X 01058634A IN
Surgical Critical Care Physician 2086S0102X C54740 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150821013331 CA Practitioner - Critical Care (Intensivists)Practitioner - General Surgery 8729210026 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Critical Care (Intensivists)Also: General Surgery
Education
Oregon Health Sciences University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trauma Team Medical Group IncorporatedGroup PAC ID 6002977642, 9 clinicians
On Call Specialists Medical Group of San Diego IncGroup PAC ID 7911395231, 145 clinicians

Practice addresses (Care Compare)

4077 5TH Ave
San Diego, CA 92103-2105
Phone (619) 298-3100

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
73.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01058634AINMDAerospace Medicine Physician
C54740CAMDSurgical Critical Care Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Surgeons of Orange a Medical Group Surgical Critical Care CurrentSince Sep 1, 2022 Accepting new patients
Trauma Team Medical Group Incorporated CurrentSince Jun 6, 2015 Accepting new patients
Emergency and Acute Care Medical Corporation CurrentSince Jun 8, 2019 Accepting new patients
Scripps Health Surgical Critical Care Current Accepting new patients
Regents of the University of California CurrentSince Aug 22, 2020 Accepting new patients
Regents of the University of California Surgical Critical Care CurrentSince Aug 22, 2020 Accepting new patients
On Call Specialists Medical Group of San Diego, Inc. CurrentSince Jun 1, 2023 Accepting new patients
University of California Irvine Past Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients
University of California Irvine Past Accepting new patients

Locations

27700 Medical Center Rd
Mission Viejo, CA 92691
Phone (949) 364-7744

27700 Medical Center Rd
#1182
Mission Viejo, CA 92691

101 The City Dr S
Orange, CA 92868
Phone (714) 456-6054

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

650 E Devon Ave
Ste 165
Itasca, IL 60143
Phone (630) 285-1040

Interoperability endpoints

  • Direct secure messaging: mtadlock31705@scrippshlth.medalliesdirect.net

Organizations & group practices 11

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

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600732800000",
    "number": "1881666956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "800-926-8273",
            "fax_number": "619-532-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TADLOCK",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2020-09-22",
        "certification_date": "2020-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083A0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Aerospace Medicine",
            "state": "IN",
            "license": "01058634A",
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "CA",
            "license": "C54740",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.