NPIMap

Individual provider Active NPI

Herbert S. Tiquia, MD

  • Nephrology Physician
  • Garden Grove, CA
National Provider Identifier
1902875693
Registry record updated Sep 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A63879 Issued in CA
Practice address
12665 Garden Grove Blvd Ste 211
Garden Grove, CA 92843-1916
Phone
(714) 636-2890
NPI assigned
Mar 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X A63879 CA Primary

Addresses

Primary practice location

12665 Garden Grove Blvd Ste 211
Garden Grove, CA 92843-1916

Mailing address

12665 Garden Grove Blvd. Ste 211
Garden Grove, CA 92843-1916
Phone (714) 636-2890

Other identifiers 1

IdentifierTypeStateIssuer
ZZZ75439ZMedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040228000548 CA Practitioner - Nephrology 4486541091 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
University of California, Davis School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern California Kidney Consultants IncGroup PAC ID 6103811286, 21 clinicians

Practice addresses (Care Compare)

12665 Garden Grove Blvd
Suite 211
Garden Grove, CA 92843-1916
Phone (714) 636-2890

Hospital & facility affiliations

  • DaVita Brea Dialysis Center Dialysis facility, Brea, CA, CCN 052621
  • DaVita Bastanchury Dialysis Dialysis facility, Fullerton, CA, CCN 552759
  • DaVita Garden Grove Harbor Dialysis Dialysis facility, Garden Grove, CA, CCN 552781
  • Providence St. Jude Medical Center Hospital, Fullerton, CA, CCN 050168

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A63879CAMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Kidney Consultants Inc. Nephrology CurrentSince Jul 1, 2001 Accepting new patients
Anaheim Global Medical Center, Inc Past Accepting new patients
Edisto Dialysis LLC PastSince Jan 25, 2018 Accepting new patients
Anaheim Memorial Medical Center Past Accepting new patients
Orange County Global Medical Center, Inc Past Accepting new patients
Alta Newport Hospital, LLC Past Accepting new patients
Chapman Medical Center Inc Past Accepting new patients
South Coast Global Medical Center, Inc Past Accepting new patients
Orange Coast Memorial Medical Center Past Accepting new patients
Dignity Health Past Accepting new patients
University of California Irvine Past Accepting new patients
St Jude Hospital Inc Past Accepting new patients
University of California Irvine Past Accepting new patients
St. Joseph Health Northern California, LLC Past Accepting new patients

Locations

1019 W La Palma Ave
Unit A
Anaheim, CA 92801
Phone (714) 364-4441

100 E Valencia Mesa Dr
Ste 100
Fullerton, CA 92835
Phone (714) 525-4185

100 E Valencia Mesa Dr
Fullerton, CA 92835
Phone (714) 447-5027

100 E Valencia Mesa Dr
Ste 217
Fullerton, CA 92835
Phone (714) 525-7177

12665 Garden Grove Blvd
Ste 211
Garden Grove, CA 92843
Phone (714) 636-2890

5451 La Palma Ave
Ste 47
La Palma, CA 90623
Phone (714) 226-0818

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: herbert.tiquia.1@21072.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/21072/brand/1/csg/1/fhir/r4

Organizations & group practices 14

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 14

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189123200000",
    "number": "1902875693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD. STE 211",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431916",
            "telephone_number": "714-636-2890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12665 GARDEN GROVE BLVD STE 211",
            "city": "GARDEN GROVE",
            "state": "CA",
            "postal_code": "928431916",
            "telephone_number": "714-636-2890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIQUIA",
        "first_name": "HERBERT",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-15",
        "last_updated": "2007-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A63879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ75439Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garden Grove, CA

Sources for this page

Verify at the official NPI Registry.