Ocean Beach Medical Group

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

G19279 Issued in CA

Legal business name

OCEAN BEACH MEDICAL GROUP

Practice address

1947 Cable St
San Diego, CA 92107-2807

Phone

(619) 223-7164

Fax

(619) 223-5443

NPI assigned

Jul 29, 2006

Last updated

Jun 18, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jeoffry Bruce Gordon, MDNPI 1649263682

Title

Owner

Phone

(619) 223-7164

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

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.

• Jeoffry Bruce Gordon, MD

  • Family Medicine Physician
  • San Diego, CA
  • NPI 1649263682
  Authorized official Same address or phone

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1992710826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1947 CABLE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921072807",
            "telephone_number": "619-223-7164",
            "fax_number": "619-223-5443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1947 CABLE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921072807",
            "telephone_number": "619-223-7164",
            "fax_number": "619-223-5443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCEAN BEACH MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "JEOFFRY",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-223-7164",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "G19279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G192790",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Occupational Health Centers of California, a Medical Corporation (Concentra Medical Center)
• Occupational Health Centers of California, a Medical Corporation (Concentra Medical Center)
• Occupational Testing & Evaluation
• Ocd Anxiety Centers California LLC
• Ocean Beach Medical Group
• Ocean Beach Speech
• Ocean Breeze Hospice, Inc.
• Ocean Pacific Companies, LLC (Ocean Pacific Gym and Wellness, LLC)
• Oceanside Healthcare, Inc. (Seaport Home Health)
• Oceanside Healthcare, Inc. (Seaport Hospice)

• Family Medicine Physician in San Diego, CA
• Providers in San Diego, 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 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.