NPIMap

Organization Active NPI

Monterey OBGYN Medical Group Inc

  • Specialist
  • Rancho Mirage, CA
National Provider Identifier
1881861797
Registry record updated May 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A44682 Issued in CA
Legal business name
MONTEREY OBGYN MEDICAL GROUP INC
Practice address
72780 Country Club Dr Ste A103
Rancho Mirage, CA 92270
Phone
(760) 779-5511
Fax
(760) 773-3320
NPI assigned
May 9, 2008
Last updated
May 9, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 9, 2008

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

Authorized official

Name
Mr. Enrique G Jacome, MDNPI 1942300942
Title
Owner/Physician
Phone
(760) 779-5511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A44682 CA Primary

Addresses

Primary practice location

72780 Country Club Dr Ste A103
Rancho Mirage, CA 92270

Mailing address

72780 Country Club Dr Ste A103
Rancho Mirage, CA 92270
Phone (760) 779-5511

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080909000581 CA Part B Supplier - Clinic/Group Practice 3678649084 Receives reassigned benefits from 3 practitioners
Practice locations: Rancho Mirage, CA

National Provider Directory

National Provider Directory

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 4

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": "1210291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210291200000",
    "number": "1881861797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR STE A103",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "92270",
            "telephone_number": "760-779-5511",
            "fax_number": "760-773-3320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72780 COUNTRY CLUB DR STE A103",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "92270",
            "telephone_number": "760-779-5511",
            "fax_number": "760-773-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTEREY OBGYN MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-09",
        "last_updated": "2008-05-09",
        "status": "A",
        "authorized_official_last_name": "JACOME",
        "authorized_official_first_name": "ENRIQUE",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "760-779-5511",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A44682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; 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.