Carlsbad Village Family Practice Medical Associates Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A6701 Issued in CA

Legal business name

CARLSBAD VILLAGE FAMILY PRACTICE MEDICAL ASSOCIATES INC

Practice address

2801 Jefferson St
Carlsbad, CA 92008-1720

Phone

(760) 729-4952

Fax

(760) 729-2738

NPI assigned

Jun 15, 2006

Organization subpart

No

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

Authorized official

Name

Mahyar Ajir, DONPI 1518999218

Title

President

Phone

(760) 729-4952

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Tax ID family

Carlsbad Village Family Practice Medical Associates Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Carlsbad Village Family Practice Medical Associates, Inc

  • Family Medicine Physician
  • Carlsbad, CA
  • NPI 1366872681
  NPD tax ID
• Carlsbad Village Family Practice Medical Associates, Inc

  • Family Medicine Physician
  • Carlsbad, CA
  • NPI 1376957142
  NPD tax ID

Locations

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 3

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

• Mahyar Ajir, D.O.

  • Family Medicine Physician
  • Carlsbad, CA
  • NPI 1518999218
  Medicare reassignment Care Compare group NPD Authorized official
• Elaheh Etedali, D.O.

  • Family Medicine Physician
  • Carlsbad, CA
  • NPI 1972535581
  Medicare reassignment Care Compare group NPD
• Lori Kealyn Fisher-Gamez, NURSE PRACTITIONER

  • Nurse Practitioner
  • Oceanside, CA
  • NPI 1558861740
  Medicare reassignment NPD

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403136000000",
    "number": "1972547644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2801 JEFFERSON ST",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920081720",
            "telephone_number": "760-729-4952",
            "fax_number": "760-729-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 JEFFERSON ST",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920081720",
            "telephone_number": "760-729-4952",
            "fax_number": "760-729-2738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLSBAD VILLAGE FAMILY PRACTICE MEDICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2014-06-19",
        "status": "A",
        "authorized_official_last_name": "AJIR",
        "authorized_official_first_name": "MAHYAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-729-4952",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A6683",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A6701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0098810",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "ZZZ09018Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carlsbad Rehabilitation Partners
• Carlsbad Relationship Counseling Center & Psychotherapy, Inc.
• Carlsbad Speech Therapy Inc.
• Carlsbad Surgery Center, LLC
• Carlsbad Unified School District
• Carlsbad Village Family Practice Medical Associates, Inc
• Carlsbad Village Family Practice Medical Associates, Inc
• Carlsbad Village Orthodontics
• Carlsbadds Pediatric Smiles
• Gregory Mark Carlson, D.D.S.

• Family Medicine Physician in Carlsbad, CA
• Providers in Carlsbad, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2014; 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.