SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP (NPI# 1023425972) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023425972 |
| Entity Type | Organization |
| Organization Name | SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP |
| Other Organization Name | TARGET CLINIC MEDICAL ASSOCIATES OF SOUTHERN CALIFORNIA |
| Practice Address |
1288 Camino Del Rio N San Diego CA 92108-1511 |
| Mailing Address |
393 E Walnut St Provider Enrollment, 3rd Floor Pasadena CA 91188-0001 |
| Practice Telephone | 8776080044 |
| Mailing Telephone | 8776080044 |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2014-10-21 |
| Authorized Official Name | DR. EDWARD M ELLISON JR. (EXECUTIVE MEDICAL DIRECTOR) |
| Authorized Official Telephone | 8776080044 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 302R00000X | Health Maintenance Organization | Managed Care Organizations |
| Other Name | Type Code |
|---|---|
| Target Clinic Medical Associates of Southern California | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982863783 | Southern California Permanente Medical Group | Health Maintenance Organization | 43112 N 15th St, Lancaster, CA 93534-6219 | 2008-06-06 |
| 1275756652 | Southern California Permanente Medical Group | Health Maintenance Organization | 2103 E Gonzales Rd, Oxnard, CA 93036-3757 | 2007-04-11 |
| 1891873303 | Southern California Permanente Medical Group | Clinical Medical Laboratory | 11668 Sherman Way, N Hollywood, CA 91605-5831 | 2006-11-01 |
| 1861424376 | Southern California Permanente Medical Group | Health Maintenance Organization | 3733 San Dimas St, Bakersfield, CA 93301-1407 | 2006-07-07 |
| 1316572753 | Southern California Permanente Medical Group | Health Maintenance Organization | 9100 Rosedale Hwy, Bakersfield, CA 93312-2143 | 2020-03-05 |
| 1821635079 | Southern California Permanente Medical Group | Health Maintenance Organization | 3471 W Century Blvd, Inglewood, CA 90303-1218 | 2019-12-06 |
| 1316409410 | Southern California Permanente Medical Group | Health Maintenance Organization | 19105 Golden Valley Rd, Santa Clarita, CA 91387-1428 | 2019-04-05 |
| 1942787114 | Southern California Permanente Medical Group | Health Maintenance Organization | 3600 Rosemead Blvd, Rosemead, CA 91770-2066 | 2018-07-20 |
| 1164914115 | Southern California Permanente Medical Group | Health Maintenance Organization | 2700 W 120th St, Hawthorne, CA 90250-3388 | 2018-06-05 |
| 1013409036 | Southern California Permanente Medical Group | Health Maintenance Organization | 8999 Balboa Blvd, Northridge, CA 91325-2608 | 2018-06-05 |
| Street Address |
1288 CAMINO DEL RIO N |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92108-1511 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982626677 | Garfield Beach Cvs LLC | Durable Medical Equipment & Medical Supplies | 1288 Camino Del Rio N, San Diego, CA 92108-1511 | 2006-07-24 |
| 1124632021 | Sandra Choi | Pharmacist | 1288 Camino Del Rio N, San Diego, CA 92108-1511 | 2020-09-08 |
| 1134730138 | Morgan Yetter | Pharmacist | 1288 Camino Del Rio N, San Diego, CA 92108-1511 | 2020-08-12 |
| 1659918860 | Vincent Phuong Tran | Pharmacist | 1288 Camino Del Rio N, San Diego, CA 92108-1511 | 2019-12-06 |
| 1912565987 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 1288 Camino Del Rio N, San Diego, CA 92108-1511 | 2019-06-04 |
| 1801373238 | Khurram Javed | Pharmacy | 1288 Camino Del Rio N, San Diego, CA 92108-1511 | 2018-07-27 |
| 1144616426 | Alexandra Tkatch | Pharmacist | 1288 Camino Del Rio N, San Diego, CA 92108-1511 | 2015-04-13 |
| 1619309895 | Tran Nguyen Singh | Pharmacist | 1288 Camino Del Rio N, 1410, San Diego, CA 92108-1511 | 2013-07-30 |
| 1013356419 | Shannon Uclaray | Pharmacist | 1288 Camino Del Rio N, San Diego, CA 92108-1511 | 2013-06-18 |
| 1699026849 | Thomas Ngo | Pharmacist | 1288 Camino Del Rio N, T-1410, San Diego, CA 92108-1511 | 2012-09-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952902801 | Keri Castaneda | Behavior Technician | 025 Camino Del Rio South Suite 101, San Diego, CA 92108 | 2020-11-06 |
| 1457963738 | Diyana Giorgees | Case Manager/Care Coordinator | 5005 Texas Street, St. 203, San Diego, CA 92108 | 2020-08-19 |
| 1780211896 | Lori Mildred Jerman | Marriage & Family Therapist | Healthy Minds Counseling Services, 1455 Frazee Road, Suite 880, San Diego, CA 92108 | 2020-03-26 |
| 1285260737 | Demetrius Anderson | Counselor | Telecare Corporation Ihot, 1660 Hotel Circle North, Suite 101, San Deigo, CA 92108 | 2020-03-17 |
| 1033742465 | Dasc Medical Inc | Durable Medical Equipment & Medical Supplies | 5520 Gill Village Way, 907, San Diego, CA 92108 | 2020-02-13 |
| 1508401092 | Chanda Denee Kizer | Marriage & Family Therapist | 3517 Camino Del Rio N, Suite 407, San Diego, CA 92108 | 2019-11-08 |
| 1225695562 | Jenna Rose Shurer | Nurse Practitioner | 5030 Camino De La Siesla Ste 106, San Diego, CA 92108 | 2019-05-22 |
| 1952967812 | Martha Kebede Mekonen | Chiropractor | 2667 Camino Del Rio South, Suite #313, San Diego, CA 92108 | 2019-05-16 |
| 1053886135 | Andrea Jiselly Munoz | Behavior Technician | 3505 Camino Del Rio South, Suite 200, San Diego, CA 92108 | 2018-10-04 |
| 1386128916 | Sarah Elisabeth Smith | Counselor | 7575 Metropolitan Dr., San Diego, CA 92108 | 2018-09-19 |
| Find all providers in zip 92108 | ||||
| Taxonomy Code | 302R00000X |
| Grouping | Managed Care Organizations |
| Classification | Health Maintenance Organization |
| (1) A form of health insurance in which its members prepay a premium for the HMO’s health services which generally include inpatient and ambulatory care. For the patient, an HMO means reduced out-of-pocket costs (i.e. no deductible), no paperwork (i.e. insurance forms), and only a small copayment for each office visit to cover the paperwork handled by the HMO; (2) A organization of health care personnel and facilities that provides a comprehensive range of health services to an enrolled population for a fixed sum of money paid in advance for a specified period of time. These health services include a wide variety of medical treatments and consults, inpatient and outpatient hospitalization, home health service, ambulance service, and sometimes dental and pharmacy services. The HMO may be organized as a group model, an individual practice association (IPA), a network model or a staff model. |
| Notes: Source: (1) Medical Interface: Managed Care A thru Z- Managed Care Terms published by Medicom International, Bronxville, New York Telephone (914) 337-5023, p. 20; (2) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 58 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851921860 | Jj Physicians Group, Inc. | Health Maintenance Organization | 7825 Engineer Rd Ste 101, San Diego, CA 92111-1929 | 2020-01-17 |
| 1821503392 | Aetna Better Health of California Inc. | Health Maintenance Organization | 10260 Meanley Dr, San Diego, CA 92131-3009 | 2017-12-06 |
| 1790134542 | Jeanna Mae Castro | Health Maintenance Organization | 3609 4th Ave, San Diego, CA 92103-4105 | 2016-06-11 |
| 1679831325 | University of California San Diego | Health Maintenance Organization | 4527 Contour Blvd, Unir 7, San Diego, CA 92115-3464 | 2012-05-01 |
| 1700186616 | Seniors of San Diego | Health Maintenance Organization | 5019 Surfside Dr, San Diego, CA 92154-8449 | 2010-10-26 |
| 1831422203 | Stairway Outreach, Inc. | Health Maintenance Organization | 16885 Via Del Campo Ct, Suite 210, San Diego, CA 92127-1721 | 2009-09-16 |
| 1013193341 | Stg International | Health Maintenance Organization | 1717 Evergreen St, San Diego, CA 92106-1901 | 2008-01-16 |
| 1972794089 | Sombath Senethong, M.d. | Health Maintenance Organization | 1748 Euclid Ave, San Diego, CA 92105-5415 | 2007-08-05 |
| 1023180189 | Mission Medical Group of The Inland Empire | Health Maintenance Organization | 9275 Sky Park Ct Ste 400, San Diego, CA 92123-4386 | 2006-11-14 |
| 1407955016 | Beth Corrick Mft | Health Maintenance Organization | 5752 Oberlin Dr Ste 203, San Diego, CA 92121-1749 | 2006-09-21 |
| 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.