Individual provider Active NPI

Cecilia T Pham, DO

  • Adult Medicine Physician
  • Costa Mesa, CA
National Provider Identifier
1962031294
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Medicine PhysicianTaxonomy code 207QA0505X
License
20A21614 Issued in CA
Practice address
1190 Baker St Ste 100
Costa Mesa, CA 92626-4105
Phone
(949) 791-3250
Fax
(949) 791-3261
NPI assigned
Apr 7, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Adult Medicine Physician 207QA0505X 20A21614 CA Primary

Addresses

Primary practice location

1190 Baker St Ste 100
Costa Mesa, CA 92626-4105

Mailing address

624 E Front Ave
Spokane, WA 99202-2139
Phone (509) 626-9900

Other practice location 1

624 E Front Ave
Spokane, WA 99202-2139
Phone (509) 626-9900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

1 Hoag Dr
Newport Beach, CA 92663-4162

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.51 of 100Reported as group
Quality
84.12
Promoting interoperability
100
Improvement activities
40
Cost
74.24

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
20A21614CAMDAdult Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hoag Clinic CurrentSince Sep 18, 2023 Accepting new patients

Locations

1170 Baker St
Ste H1
Costa Mesa, CA 92626
Phone (877) 464-2778

1190 Baker St
Ste 100
Costa Mesa, CA 92626
Phone (714) 668-2500

1 Hoag Dr
Newport Beach, CA 92663
Phone (877) 742-4624

1031 Avenida Pico
Ste 204
San Clemente, CA 92673
Phone (949) 829-5533

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10944/brand/3/csg/1/fhir/r4
  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1586217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1962031294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "624 E FRONT AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992022139",
            "telephone_number": "509-626-9900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 BAKER ST STE 100",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "926264105",
            "telephone_number": "949-791-3250",
            "fax_number": "949-791-3261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "624 E Front Ave",
            "address_purpose": "LOCATION",
            "city": "Spokane",
            "state": "WA",
            "postal_code": "992022139",
            "country_code": "US",
            "telephone_number": "509-626-9900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAM",
        "first_name": "CECILIA",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-07",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0505X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adult Medicine",
            "state": "CA",
            "license": "20A21614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Costa Mesa, CA

Sources for this page

Verify at the official NPI Registry.