Surgical Associates of la Jolla Medical Group, Inc.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

SURGICAL ASSOCIATES OF LA JOLLA MEDICAL GROUP, INC.

Practice address

9850 Genesee Ave
Suite 660
La Jolla, CA 92037-1224

Phone

(858) 452-5054

Fax

(858) 452-5097

NPI assigned

Jul 14, 2006

Organization subpart

No

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

Authorized official

Name

Paul Hyde, M.D.NPI 1225056906

Title

President

Phone

(858) 452-5054

Specialties & licenses 1

Addresses

Other identifiers 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

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)…

Interoperability endpoints

• Direct secure messaging: msherman28378@scrippshlth.medalliesdirect.net
• Direct secure messaging: phyde28418@scrippshlth.medalliesdirect.net
• Direct secure messaging: bleedy41792@scrippshlth.medalliesdirect.net
• Direct secure messaging: colson28118@scrippshlth.medalliesdirect.net

Practitioners 7

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

• Paul Vincent Bernard Hyde, M.D.

  • Surgery Physician
  • La Jolla, CA
  • NPI 1225056906
  Medicare reassignment NPD Authorized official
• Cheryl Lorraine Olson, M.D.

  • Surgery Physician
  • La Jolla, CA
  • NPI 1043238728
  Medicare reassignment Care Compare group NPD
• Mark Jason Sherman, M.D.

  • Surgery Physician
  • La Jolla, CA
  • NPI 1134147812
  Medicare reassignment Care Compare group NPD
• Anna Ruth Spain

  • Surgical Physician Assistant
  • La Jolla, CA
  • NPI 1790530152
  Medicare reassignment Care Compare group NPD
• Samuel Zuber, MD

  • Surgery Physician
  • La Jolla, CA
  • NPI 1346634219
  Medicare reassignment Care Compare group NPD
• Emily Muff, PA

  • Physician Assistant
  • San Diego, CA
  • NPI 1770275059
  Medicare reassignment Care Compare group
• Brooke Caroline Leedy, PA-C

  • Physician Assistant
  • Brawley, CA
  • NPI 1659541027
  Medicare reassignment

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1952327165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE",
            "address_2": "SUITE 660",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371224",
            "telephone_number": "858-452-5054",
            "fax_number": "858-452-5097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9850 GENESEE AVE",
            "address_2": "SUITE 660",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371224",
            "telephone_number": "858-452-5054",
            "fax_number": "858-452-5097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL ASSOCIATES OF LA JOLLA MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HYDE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-452-5054",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0087870",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Mortensen Sumner, PH.D.
• Cheng Sun, ANP
• Ji Sun, PHARMD/PH.D.
• Wynnshang Chen Sun, MD
• Sunil Bhoyrul MD Incorporated
• Dalga David Surofchy, PHARM.D
• Susan P Detwiler MD Inc
• Susan P Detwiler MD Inc
• Pallavi Suvarna
• Julie Anna Suyama, M.D., PH.D.

• Surgery Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.