NPIMap

Organization Active NPI

Emergency Medicine Group of Encinitas, Inc

Doing business as Coastline Emergency Physician's Medical Group, Inc.

  • Emergency Medicine Physician
  • Encinitas, CA
National Provider Identifier
1902805179
Registry record updated Apr 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
18530 Issued in CA
Legal business name
EMERGENCY MEDICINE GROUP OF ENCINITAS, INC
Doing business as
Coastline Emergency Physician's Medical Group, Inc.
Practice address
354 Santa Fe Dr
Encinitas, CA 92024-5142
Phone
(760) 753-1362
Fax
(760) 230-2253
NPI assigned
Jul 19, 2005
Last updated
Apr 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2015

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

Authorized official

Name
Dr. Ronald J. Maccormick, M.D.NPI 1699775213
Title
President
Phone
(760) 230-2251

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 18530 CA Primary

Addresses

Primary practice location

354 Santa Fe Dr
Encinitas, CA 92024-5142

Mailing address

PO Box 230760
Encinitas, CA 92023-0760
Phone (760) 753-1362

Other names 1

  • COASTLINE EMERGENCY PHYSICIAN'S MEDICAL GROUP, INC. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050210000997 CA Part B Supplier - Clinic/Group Practice 7618929381 Receives reassigned benefits from 57 practitioners
Practice locations: Encinitas, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 83

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.

View all 83

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428537600000",
    "number": "1902805179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 230760",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920230760",
            "telephone_number": "760-753-1362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "354 SANTA FE DR",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920245142",
            "telephone_number": "760-753-1362",
            "fax_number": "760-230-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMERGENCY MEDICINE GROUP OF ENCINITAS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2015-04-09",
        "status": "A",
        "authorized_official_last_name": "MACCORMICK",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-230-2251",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "18530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COASTLINE EMERGENCY PHYSICIAN'S MEDICAL GROUP, INC.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Encinitas, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; 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.