NPIMap

Organization Active NPI

Sand Canyon Medical Group

  • Urgent Care Clinic/Center
  • Irvine, CA
National Provider Identifier
1962688390
Registry record updated Aug 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
SAND CANYON MEDICAL GROUP
Practice address
16100 Sand Canyon Ave
Suite 150
Irvine, CA 92618-3716
Phone
(949) 417-0272
NPI assigned
Jan 16, 2008
Last updated
Aug 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2008

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

Authorized official

Name
Matthew Mullarky, M.D.
Title
President
Phone
(949) 417-0272

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU Primary

Addresses

Primary practice location

16100 Sand Canyon Ave
Suite 150
Irvine, CA 92618-3716

Mailing address

PO Box 96365
Oklahoma City, OK 73143-6365

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080804000619 CA Part B Supplier - Clinic/Group Practice 9436223781 Receives reassigned benefits from 14 practitioners
Practice locations: Irvine, CA; Laguna Hills, CA

National Provider Directory

National Provider Directory

Locations

15775 Laguna Canyon Rd
Ste 100
Irvine, CA 92618
Phone (949) 417-0272

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1200441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1962688390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96365",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731436365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16100 SAND CANYON AVE",
            "address_2": "SUITE 150",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183716",
            "telephone_number": "949-417-0272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAND CANYON MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-16",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "MULLARKY",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-417-0272",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; 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.