NPIMap

Organization Active NPI

Memorialcare Medical Group, Inc.

Doing business as MemorialCare Medical Group - Rancho Santa Margarita

  • Non-Pharmacy Dispensing Site
  • Rancho Santa Margarita, CA
National Provider Identifier
1912049578
Registry record updated Apr 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
C52292 Issued in CA
Legal business name
MEMORIALCARE MEDICAL GROUP, INC.
Doing business as
MemorialCare Medical Group - Rancho Santa Margarita
Practice address
29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651
Phone
(949) 459-9968
NPI assigned
Feb 12, 2007
Last updated
Apr 3, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2013

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

Authorized official

Name
Kenny Heine
Title
VP of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X C52292 CA Primary

Addresses

Primary practice location

29472 Avenida de Las Bandera
Rancho Santa Margarita, CA 92688-2651

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705
Phone (858) 625-2990

Other names 1

  • MemorialCare Medical Group - Rancho Santa Margarita Doing business as

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
05D0945796Memorialcare Medical Group29472 Avenida de Las Banderas, Rancho Santa Margarita, CA 92688Provider-performed microscopyMay 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
BPMG - Costa Mesa9 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 8

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

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1912049578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29472 AVENIDA DE LAS BANDERA",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "926882651",
            "telephone_number": "949-459-9968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIALCARE MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-02-12",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "C52292",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MemorialCare Medical Group - Rancho Santa Margarita",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rancho Santa Margarita, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; 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.