Pacific Crest Medical Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PACIFIC CREST MEDICAL GROUP INC

Practice address

34052 La PLZ
Suite 101
Dana Point, CA 92629-2587

Phone

(949) 388-4316

Fax

(949) 388-4319

NPI assigned

Jul 6, 2006

Organization subpart

No

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

Authorized official

Name

Lesley Roberts

Title

Controller

Phone

(949) 388-4316

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

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

CLIA laboratory certificates

Tax ID family

Pacific Crest Medical Group2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Pacific Crest Medical Group, Inc.

  • Family Medicine Physician
  • Laguna Niguel, CA
  • NPI 1225011976
  NPD tax ID

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14459/brand/1/csg/1/fhir/r4

Practitioners 6

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

• Richard Kempert, M.D.

  • Family Medicine Physician
  • Dana Point, CA
  • NPI 1861598500
  Medicare reassignment Care Compare group
• Larry Snyder, M.D.

  • Family Medicine Physician
  • Dana Point, CA
  • NPI 1902902653
  Medicare reassignment Care Compare group
• Jason A Black, M.D.

  • Internal Medicine Physician
  • Murrieta, CA
  • NPI 1073587887
  NPD (past)
• Vincent Rudolph Duda, MD

  • Internal Medicine Physician
  • Laguna Niguel, CA
  • NPI 1104883610
  NPD (past)
• Denise Park, MD

  • Internal Medicine Physician
  • Cerritos, CA
  • NPI 1518015338
  NPD (past)
• Russell J Gross, MD

  • Vascular Surgery Physician
  • Covington, TN
  • NPI 1548228588
  NPD (past)

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328486400000",
    "number": "1932131653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3630",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926298630",
            "telephone_number": "949-388-4316",
            "fax_number": "949-388-4319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34052 LA PLZ",
            "address_2": "SUITE 101",
            "city": "DANA POINT",
            "state": "CA",
            "postal_code": "926292587",
            "telephone_number": "949-388-4316",
            "fax_number": "949-388-4319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC CREST MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2012-02-06",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "LESLEY",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "949-388-4316"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Dana Point, CA
• Providers in Dana Point, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.