Organization Active NPI

Girard Orthopaedic Surgeons Medical Group,. Inc

  • Specialist
  • San Diego, CA
National Provider Identifier
1962438564
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G76060 Issued in CA
Legal business name
GIRARD ORTHOPAEDIC SURGEONS MEDICAL GROUP,. INC
Practice address
9333 Genesee Ave Ste 350
San Diego, CA 92121-2103
Phone
(858) 455-6460
Fax
(858) 455-7197
NPI assigned
Jun 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Dr. Michael P Kimball, M.D.NPI 1588648653
Title
President
Phone
(858) 455-6460

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X G76060 CA Primary

Addresses

Primary practice location

9333 Genesee Ave Ste 350
San Diego, CA 92121-2103

Mailing address

9333 Genesee Ave Ste 350
San Diego, CA 92121-2103
Phone (858) 455-6460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040303000834 CA Part B Supplier - Clinic/Group Practice 6709773773 Receives reassigned benefits from 10 practitioners
Practice locations: Chula Vista, CA; La Mesa, CA; San Diego, CA
O20100930076867 CA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 6709773773 Practice locations: San Diego, CA

National Provider Directory

National Provider Directory

Locations

480 Fourth Ave
Ste 509
Chula Vista, CA 91910
Phone (619) 651-9760

480 Fourth Ave
Ste 408
Chula Vista, CA 91910

1679 E Main St
Ste 102
El Cajon, CA 92021
Phone (619) 441-1907

4130 La Jolla Village Dr
Ste 306
La Jolla, CA 92037
Phone (858) 455-6460

8851 Center Dr
Ste 601
La Mesa, CA 91942
Phone (619) 441-9811

9333 Genesee Ave
Ste 350B
San Diego, CA 92121
Phone (619) 254-5239

9333 Genesee Ave
Ste 350A
San Diego, CA 92121

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 & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1962438564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9333 GENESEE AVE STE 350",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212103",
            "telephone_number": "858-455-6460",
            "fax_number": "858-455-7197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9333 GENESEE AVE STE 350",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212103",
            "telephone_number": "858-455-6460",
            "fax_number": "858-455-7197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIRARD ORTHOPAEDIC SURGEONS MEDICAL GROUP,. INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-24",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "KIMBALL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-455-6460",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G76060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.