NPIMap

Organization Active NPI

Cassidy Medical Group - OB-GYN

  • Obstetrics & Gynecology Physician
  • Vista, CA
National Provider Identifier
1881761047
Registry record updated Oct 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
CASSIDY MEDICAL GROUP - OB-GYN
Practice address
145 Thunder Dr
Vista, CA 92083-6010
Phone
(760) 941-1440
Fax
(760) 630-5477
NPI assigned
Nov 30, 2006
Last updated
Oct 14, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
CASSIDY MEDICAL GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 14, 2010

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

Authorized official

Name
Judith M Krueger
Title
Executive Director
Phone
(760) 630-5487

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary

Addresses

Primary practice location

145 Thunder Dr
Vista, CA 92083-6010

Mailing address

145 Thunder Dr
Vista, CA 92083-6010
Phone (760) 941-1440

Other identifiers 2

IdentifierTypeStateIssuer
GR0060601MedicaidCA
3019OtherCANEIC SITE ID, NSF BAO-7

National Provider Directory

National Provider Directory
Tax ID family
Cassidy Medical Group Inc5 organizations share this tax ID, including this one
Part of
Cassidy Medical Group Inc

Other organizations with this tax ID 4

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

Locations

145 Thunder Dr
Vista, CA 92083
Phone (760) 630-5487

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287014400000",
    "number": "1881761047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 THUNDER DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836010",
            "telephone_number": "760-941-1440",
            "fax_number": "760-630-5477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 THUNDER DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920836010",
            "telephone_number": "760-941-1440",
            "fax_number": "760-630-5477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASSIDY MEDICAL GROUP - OB-GYN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CASSIDY MEDICAL GROUP",
        "enumeration_date": "2006-11-30",
        "last_updated": "2010-10-14",
        "status": "A",
        "authorized_official_last_name": "KRUEGER",
        "authorized_official_first_name": "JUDITH",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "760-630-5487"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0060601",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIC SITE ID, NSF BAO-7",
            "identifier": "3019",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; 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.