NPIMap

Organization Active NPI

South Coast Pediatrics

  • Pediatric Adolescent Medicine Physician
  • Anaheim, CA
National Provider Identifier
1891860748
Registry record updated Dec 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
SOUTH COAST PEDIATRICS
Practice address
1720 W Ball Rd
Ste.#1
Anaheim, CA 92804-5500
Phone
(714) 991-5141
Fax
(714) 991-5144
NPI assigned
Nov 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2011

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

Authorized official

Name
Dr. Jacob Wolsztejn, M.D.NPI 1699708487
Title
President
Phone
(714) 991-5141

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
Pediatric Adolescent Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2080A0000X Primary

Addresses

Primary practice location

1720 W Ball Rd
Ste.#1
Anaheim, CA 92804-5500

Mailing address

1720 W Ball Rd
Ste.#1
Anaheim, CA 92804-5500
Phone (714) 991-5141

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D1008631South Coast Pediatrics1720 W Ball Rd Ste 1, Anaheim, CA 92804Certificate of waiverJan 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
South Coast Pediatrics3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1720 W Ball Rd
Ste 1
Anaheim, CA 92804
Phone (714) 991-5141

2650 S Bristol St
Ste 101
Santa Ana, CA 92704
Phone (714) 754-1444

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 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323302400000",
    "number": "1891860748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 W BALL RD",
            "address_2": "STE.#1",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928045500",
            "telephone_number": "714-991-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 W BALL RD",
            "address_2": "STE.#1",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928045500",
            "telephone_number": "714-991-5141",
            "fax_number": "714-991-5144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COAST PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2011-12-08",
        "status": "A",
        "authorized_official_last_name": "WOLSZTEJN",
        "authorized_official_first_name": "JACOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-991-5141",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.