San Diego Primary Care Medical Group

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

G31968 Issued in CA

Legal business name

SAN DIEGO PRIMARY CARE MEDICAL GROUP

Doing business as

Clairemont Family Medical Clinic

Practice address

3737 Moraga Ave
Ste B408
San Diego, CA 92117-5364

Phone

(858) 292-8885

Fax

(858) 292-0688

NPI assigned

Jan 6, 2007

Last updated

Nov 11, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Gary Kenneth Boone, M.D.NPI 1073543781

Title

President

Phone

(858) 292-8885

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Clairemont Family Medical Clinic Doing business as

Electronic endpoints 1

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

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

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.

• Gary Kenneth Boone, M.D.

  • Adult Medicine Physician
  • San Diego, CA
  • NPI 1073543781
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1168041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1932257193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 MORAGA AVE",
            "address_2": "STE B408",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921175364",
            "telephone_number": "858-292-8885",
            "fax_number": "858-292-0688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 MORAGA AVE",
            "address_2": "STE B408",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921175364",
            "telephone_number": "858-292-8885",
            "fax_number": "858-292-0688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN DIEGO PRIMARY CARE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-06",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "BOONE",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-292-8885",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "G31968",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G319680",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "garyboone@sdpcmg.allscriptsdirect.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3737 Moraga Ave",
            "address_2": "Ste B408",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921175364",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Clairemont Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Clairemont Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• San Diego Pharmacy
• San Diego Physicians Clinic
• San Diego Physicians Medical Group
• San Diego Premier Surgery Center LLC
• San Diego Prep Inc
• San Diego Psychiatric Medical Group Inc
• San Diego Psychiatry, PC
• San Diego Psychological Couple Care, Inc. (San Diego Couple Care)
• San Diego Psychology & Telehealth
• San Diego Psychology Center (Deisy Cristina Boscan, Ph.D. Psychologist, Professional Corporation)

• Adult Medicine Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Adult Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; 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.