Memorial Family Medicine Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A5075 Issued in CA

Legal business name

MEMORIAL FAMILY MEDICINE MEDICAL GROUP, INC.

Doing business as

San Clemente Family Medicine

Practice address

450 E Spring St
Suite 1
Long Beach, CA 90806-1625

Phone

(562) 933-0053

Fax

(562) 933-0079

NPI assigned

Jun 22, 2010

Last updated

Jun 22, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

MEMORIAL FAMILY MEDICINE MEDICAL GROUP, INC.As reported in NPPES

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

Authorized official

Name

Dr. Susan Yvonne Melvin, D.O.NPI 1750487765

Title

President/Ceo

Phone

(562) 933-0053

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• San Clemente Family Medicine Doing business as

Tax ID family

Memorial Famil Y M2 organizations share this tax ID, including this one

Part of

Memorial Famil Y M

Other organizations with this tax ID 1

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

• San Clemente Family Medicine

  dba Memorial Family Medicine Medical Group, Inc.

  • Family Medicine Physician
  • San Clemente, CA
  • NPI 1154642452
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Memorial Family Medicine Medical Group, Inc.

  • Family Medicine Physician
  • Long Beach, CA
  • NPI 1689680001
  NPPES parent name

Practitioners 1

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.

• Susan Melvin, D.O.

  • Adolescent Medicine (Family Medicine) Physician
  • Long Beach, CA
  • NPI 1750487765
  Authorized official Same address or phone

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

{
    "created_epoch": "1277164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277164800000",
    "number": "1922329127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 AVENIDA VISTA HERMOSA",
            "address_2": "SUITE 200",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926736315",
            "telephone_number": "949-452-3199",
            "fax_number": "949-218-6866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 E SPRING ST",
            "address_2": "SUITE 1",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908061625",
            "telephone_number": "562-933-0053",
            "fax_number": "562-933-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL FAMILY MEDICINE MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL FAMILY MEDICINE MEDICAL GROUP, INC.",
        "enumeration_date": "2010-06-22",
        "last_updated": "2010-06-22",
        "status": "A",
        "authorized_official_last_name": "MELVIN",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "YVONNE",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "562-933-0053",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A5075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0071000",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Clemente Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Memorial Cardiology Medical Group, Inc
• Memorial Cardiology Medical Group, Inc
• Memorial Cardiology Medical Group, Inc
• Memorial Cardiology Medical Group, Inc
• Memorial Family Medicine Medical Group, Inc.
• Memorial Hospitalist Network
• Memorial Maritime Clinic, Inc.
• Memorial Medical Transport
• Memorial Medical Transport, Inc
• Memorial Orthopaedic Surgical Group

• Family Medicine Physician in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.