NPIMap

Organization Active NPI

Bristol Park Medical Group

  • Non-Pharmacy Dispensing Site
  • Costa Mesa, CA
National Provider Identifier
1881736445
Registry record updated May 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
A87971 Issued in CA
Legal business name
BRISTOL PARK MEDICAL GROUP
Practice address
722 Baker St
Costa Mesa, CA 92626-4320
Phone
(714) 557-6300
NPI assigned
Feb 12, 2007
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on May 29, 2009

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

Authorized official

Name
Kenny Heine
Title
Director of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X A87971 CA Primary

Addresses

Primary practice location

722 Baker St
Costa Mesa, CA 92626-4320

Mailing address

5810 Nancy Ridge Dr
San Diego, CA 92121-2834
Phone (858) 625-2990

Other names 1

  • BPMG - Costa Mesa Doing business as

National Provider Directory

National Provider Directory
Tax ID family
BPMG - Costa Mesa9 organizations share this tax ID, including this one
Part of
Tri - State Medical Group Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1243555200000",
    "number": "1881736445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 NANCY RIDGE DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212834",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 BAKER ST",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264320",
            "telephone_number": "714-557-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRISTOL PARK MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-02-12",
        "last_updated": "2009-05-29",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A87971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BPMG - Costa Mesa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Costa Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2009; 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.