BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO (NPI# 1003006628) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003006628 |
| Entity Type | Organization |
| Organization Name | BRANCH MEDICAL CLINIC NAVAL STATION SAN DIEGO |
| Practice Address |
2450 Craven Steet San Diego CA 92136-5599 |
| Mailing Address |
2450 Craven St San Diego CA 92136-5599 |
| Practice Telephone | 6195566302 |
| Practice Fax Number | 6195569419 |
| Mailing Telephone | 6195566302 |
| Mailing Fax Number | 6195569419 |
| Enumeration Date | 2007-07-30 |
| Last Update Date | 2019-04-04 |
| Authorized Official Name | MR. WILLIAM MICHAEL CONDON (NAVY MEDICINE UBO PROGRAM MANAGER) |
| Authorized Official Telephone | 2404013643 |
| Is Organization Subpart | Y |
| Parent Organization Name | NAVAL MEDICAL CENTER SAN DIEGO |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1100X |
Clinic/Center Specialization: Military/U.S. Coast Guard Outpatient |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | HSP63228F | 05 |
| Street Address |
2450 CRAVEN STEET |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92136-5599 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467930164 | Alexa Clifton | Student in an Organized Health Care Education/Training Program | 2525 Callagan Hwy, Fpo, AA 92136 | 2018-08-03 |
| 1235501321 | Family Optometric Associates of California, Inc. | Optometrist | 2260 Callahan Hwy, Bldg 3187-a, San Diego, CA 92136 | 2015-10-28 |
| 1457720427 | Andres Bargados Santamaria IIi | Military Health Care Provider | 116 Cummings Rd, San Diego, CA 92136 | 2015-09-21 |
| 1932470374 | Robert Bishop Beedles Jr. | Military Health Care Provider | 3380 Sturtevant St, Bldg 57 Second Floor, San Diego, CA 92136 | 2012-01-17 |
| 1083771877 | Brianna Leigh Rupp | General Practice | Uss Tarawa Lha 1 Fpo Ap 96622-1600, San Diego, CA 92136 | 2007-01-02 |
| 1396814836 | Alberia Joseph Davis | Military Health Care Provider | Pcd Sampson (ddg-102), 3975 Norman Scott Rd, San Diego, CA 92136 | 2006-11-07 |
| 1831275866 | Roslyn Jones Jackson | Nurse Practitioner | 2450 Craven Streeet, San Diego, CA 92136 | 2006-10-31 |
| 1699743534 | Mark L Williamson | Military Health Care Provider | 3325 Senn Road, Comdesron One Building 55 Second Floor, San Diego, CA 92136 | 2006-03-08 |
| 1467423335 | John M. Hintz | Psychologist | Branch Medical Clinic, Naval Station, San Diego, CA 92136 | 2006-01-30 |
| 1659341089 | Kenichi Carrigan | Preventive Medicine | 3235 Albacore Alley, San Diego, CA 92136 | 2006-01-26 |
| Find all providers in zip 92136 | ||||
| Taxonomy Code | 261QM1100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Military/U.S. Coast Guard Outpatient |
| The Defense Health Program or U.S. Coast Guard funded "fixed" facilities or distinct parts of a facility, providing outpatient medical and dental services, primarily for Uniformed Services beneficiaries. A "fixed" facility is a non-temporary, non-deployed facility. It includes mobile specialty units such as Magnetic Resonance Imaging (MRI) units that may furnish services at the "fixed" facility. It includes, as examples, the institutional portion of outpatient encounters (except Ambulatory Procedure Visits), supplies issued (e.g., glasses, ostomy supplies, crutches), and radiology and laboratory studies. Does not include items issued directly to a patient from an outpatient pharmacy or patient transport. |
| Notes: Source: TRICARE Management Activity Uniform Business Office User’s Guide [1/1/2005: title modified, definition added; 7/1/2006 title modified, definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023400256 | Branch Medical Clinic Mcas Miramar | Clinic/Center | Bauer Rd, Bldg 2496, San Diego, CA 92145-0001 | 2015-02-25 |
| 1730386327 | Branch Medical Clinic Ntc San Diego | Clinic/Center | 2051 Cushing Road, Bldg 624, San Diego, CA 92106-0000 | 2007-06-28 |
| 1104962448 | U.S. Coast Guard | Clinic/Center | 2734 Belknap Way, San Diego, CA 92106-6401 | 2007-01-30 |
| 1932502788 | Branch Medical Clinic Rancho Bernardo | Clinic/Center | 11770 Bernardo Plaza Ct, San Diego, CA 92128-2422 | 2014-10-07 |
| 1538480298 | Us Coast Guard | Clinic/Center | 2051 Cushing Road, Us Coast Guard, San Diego, CA 92106 | 2010-06-17 |
| 1649446857 | Branch Medical Clinic Mcrd | Clinic/Center | 35000 Guadalcanal St, Branch Medical Clinic Mcrd, San Diego, CA 92140 | 2008-05-07 |
| 1225220270 | Branch Medical Clinic Coronado | Clinic/Center | 601 Mccain Blvd, Naval Base Coronado, San Diego, CA 92135-7046 | 2007-08-14 |
| 1679771133 | Branch Medical Clinic North Island | Clinic/Center | 34520 Bob Wilson Dr, San Diego, CA 92134-2098 | 2007-07-06 |
| 1922206853 | Tricare Outpatient Clinic Clairemont | Clinic/Center | 8808 Balboa Ave, San Diego, CA 92123-1592 | 2007-07-03 |
| 1588728497 | Naval Medical Center San Diego | Clinic/Center | Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA 92134-5000 | 2006-12-22 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.