PHYSICIANS MEDICAL GROUP OF SAN JOSE, INC. (NPI# 1073648739) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073648739 |
| Entity Type | Organization |
| Organization Name | PHYSICIANS MEDICAL GROUP OF SAN JOSE, INC. |
| Practice Address |
227 N Jackson Ave San Jose CA 95116-1603 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 4083472060 |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2012-10-22 |
| Authorized Official Name | KENNY HEINE (DIRECTOR OF OPERATIONS) |
| Authorized Official Telephone | 8586252990 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | BL2431966 | CA | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891175444 | Physicians Medical Group of San Jose, Inc. | Clinic/Center | 1910 N Capitol Ave, San Jose, CA 95132-1019 | 2015-06-08 |
| 1811194509 | Physicians Medical Group of San Jose, Inc. | Non-Pharmacy Dispensing Site | 2585 Samaritan Dr, 2nd Floor, San Jose, CA 95124-4107 | 2007-06-27 |
| 1568503654 | Physicians Medical Group of San Jose, Inc. | Non-Pharmacy Dispensing Site | 625 Lincoln Ave, San Jose, CA 95126-3705 | 2007-02-09 |
| Street Address |
227 N JACKSON AVE |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95116-1603 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063461747 | Rasik Kansara | Internal Medicine | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2006-05-09 |
| 1871996520 | Misty Mallari | Registered Nurse | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2014-10-08 |
| 1427450592 | Caroline Ladines | Pharmacist | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2014-09-20 |
| 1639511488 | Maria S Govorkova | Ophthalmology | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2013-07-22 |
| 1013224633 | Verity Medical Foundation | Family Medicine | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2010-09-02 |
| 1073708541 | Vincent Liu | Internal Medicine | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2007-09-07 |
| 1750596755 | Timothy Earl Wiley | Technician/Technologist | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2007-05-11 |
| 1487708855 | Unilab Corporation | Clinical Medical Laboratory | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2007-01-23 |
| 1326132515 | Mary J. Richardson | Registered Nurse | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2006-10-03 |
| 1669576864 | Arthur Feldman | Internal Medicine | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2006-09-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821570102 | Lori Chung Cho Dmd Inc. | Clinic/Center | 150 N Jackson Ave Ste 103, San Jose, CA 95116 | 2018-09-03 |
| 1306333174 | Patrick Suezaki | Dentist | 250 Montclair Ave Ste C, San Jose, CA 95116 | 2018-04-17 |
| 1871016147 | Israel Enrique Ruiz Lora | Social Worker | 1075 East Santa Clara, San Jose, CA 95116 | 2017-07-19 |
| 1275072613 | Araceli Yazmin Garcia | Case Manager/Care Coordinator | 1652 E San Fernando St, San Jose, CA 95116 | 2017-02-17 |
| 1710304712 | Natalie K. Huynh D.d.s Inc. | Dentist | 2340 Mckee Rd #24, San Jose, CA 95116 | 2014-03-27 |
| 1437597747 | Ian Ellis Mccoy | Internal Medicine | 2360 Mckee Rd Ste 10, San Jose, CA 95116 | 2013-06-08 |
| 1588913321 | Adrian Fernandez | Counselor | 1245 East Santa Clara Street, San Jose, CA 95116 | 2012-09-07 |
| 1851678841 | Krystal Lani Subia | Counselor | 101 Jose Figueres Avenue, San Jose, CA 95116 | 2011-11-04 |
| 1255668224 | Sophia O.j.m. Dijkstra | Physical Therapist | 180 N. Jackson Ave, San Jose, CA 95116 | 2009-11-11 |
| 1255562096 | Jovan De Guzman Sedilla | Physical Therapy Assistant | 180 N. Jackson Ave., San Jose, CA 95116 | 2009-07-28 |
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| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780026518 | San Jose Doctors On Duty | Non-Pharmacy Dispensing Site | 1910 N Capitol Ave, San Jose, CA 95132-1019 | 2013-07-22 |
| 1043263189 | Planned Parenthood Mar Monte, Inc | Non-Pharmacy Dispensing Site | 1691 The Alameda, San Jose, CA 95126-2203 | 2006-05-18 |
| 1689934473 | Nguyen Ky Dpm Inc | Non-Pharmacy Dispensing Site | 660 E Santa Clara St, San Jose, CA 95112-1931 | 2012-05-25 |
| 1821227000 | South Bay Sports and Preventive Medicine Associates, Inc. | Non-Pharmacy Dispensing Site | 455 Oconnor Drive, Suite 150, San Jose, CA 95128 | 2009-07-08 |
| 1811126097 | South Bay Sports and Preventive Medicine Associates, Inc. | Non-Pharmacy Dispensing Site | 455 Oconnor Drive, Suite 150, San Jose, CA 95128 | 2009-07-08 |
| 1265661441 | South Bay Sports and Preventive Medicine Associates, Inc. | Non-Pharmacy Dispensing Site | 455 Oconnor Drive, Suite 150, San Jose, CA 95128 | 2009-07-08 |
| 1043497266 | Navani Pain Management Inc. | Non-Pharmacy Dispensing Site | 2505 Samaritan Dr, Suite #601, San Jose, CA 95124-4006 | 2008-01-30 |
| 1316120173 | W Gordon Walker, Md | Non-Pharmacy Dispensing Site | 2505 Samaritan Dr, San Jose, CA 95124-4006 | 2007-12-14 |
| 1467635466 | Ronald C. Diebel, M.d. A Professional Corporation | Non-Pharmacy Dispensing Site | 251 Oconnor Dr, Suite 1, San Jose, CA 95128-1656 | 2007-12-12 |
| 1811194509 | Physicians Medical Group of San Jose, Inc. | Non-Pharmacy Dispensing Site | 2585 Samaritan Dr, 2nd Floor, San Jose, CA 95124-4107 | 2007-06-27 |
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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.