Ciecal RC Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

A80610 Issued in CA

Legal business name

CIECAL RC INC

Doing business as

South Bay Primary Medical Group

Practice address

769 Medical Center CT
Suite 303
Chula Vista, CA 91911-6602

Phone

(619) 591-9001

Fax

(619) 591-9211

NPI assigned

Jun 8, 2016

Last updated

Nov 16, 2016By 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

Dr. Tracy Lee Polanco, M.D.NPI 1538138631

Title

Owner/President

Phone

(619) 591-9001

Specialties & licenses 2

Addresses

Other names 1

• South Bay Primary Medical Group Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 2

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.

• Tracy L. Polanco, M.D.

  • Family Medicine Physician
  • Chula Vista, CA
  • NPI 1538138631
  Medicare reassignment Care Compare group NPD Authorized official
• Leticia A. Polanco, M.D.

  • Family Medicine Physician
  • Chula Vista, CA
  • NPI 1710956818
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1465344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479254400000",
    "number": "1942659149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "769 MEDICAL CENTER CT",
            "address_2": "SUITE 303",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116602",
            "telephone_number": "619-591-9001",
            "fax_number": "619-591-9211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "769 MEDICAL CENTER CT",
            "address_2": "SUITE 303",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919116602",
            "telephone_number": "619-591-9001",
            "fax_number": "619-591-9211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIECAL RC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-08",
        "last_updated": "2016-11-16",
        "status": "A",
        "authorized_official_last_name": "POLANCO",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "619-591-9001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A80610",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "CA",
            "license": "A76528",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Bay Primary Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Primary Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.