Urology Care Center

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

G64457 Issued in CA

Legal business name

UROLOGY CARE CENTER

Practice address

1441 Avocado Ave
Suite 408
Newport Beach, CA 92660-7721

Phone

(949) 718-4315

Fax

(949) 718-4316

NPI assigned

Feb 24, 2012

Organization subpart

No

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

Authorized official

Name

Cu Ngoc Phan, MDNPI 1417003633

Title

President

Phone

(949) 718-4315

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DHCDCA
• FHIR API: https://app.meldrx.com/api/fhir/uc30744_urologycarecenter

Practitioners 1

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

• Cu Ngoc Phan, M.D.

  • Urology Physician
  • Newport Beach, CA
  • NPI 1417003633
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1330041600000",
    "number": "1982978805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 AVOCADO AVE",
            "address_2": "SUITE 408",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607721",
            "telephone_number": "949-718-4315",
            "fax_number": "949-718-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 AVOCADO AVE",
            "address_2": "SUITE 408",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607721",
            "telephone_number": "949-718-4315",
            "fax_number": "949-718-4316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UROLOGY CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-24",
        "last_updated": "2012-02-24",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "CU",
        "authorized_official_middle_name": "NGOC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-718-4315",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": "G64457",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G644570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Urology Physician in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Urology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2012; 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.