PHYSICIANS MEDICAL GROUP OF SAN JOSE, INC. (NPI# 1568503654) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568503654 |
| Entity Type | Organization |
| Organization Name | PHYSICIANS MEDICAL GROUP OF SAN JOSE, INC. |
| Practice Address |
625 Lincoln Ave San Jose CA 95126-3705 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 4082783203 |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2012-10-17 |
| 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 | A71045 | 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 |
| 1073648739 | Physicians Medical Group of San Jose, Inc. | Non-Pharmacy Dispensing Site | 227 N Jackson Ave, San Jose, CA 95116-1603 | 2007-02-22 |
| Street Address |
625 LINCOLN AVE |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95126-3705 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700850708 | Brian Farris | Internal Medicine | 625 Lincoln Ave, San Jose, CA 95126-3705 | 2006-02-15 |
| 1447817309 | Liane Christine Tongol | Physician Assistant | 625 Lincoln Ave, San Jose, CA 95126-3785 | 2019-05-24 |
| 1689014755 | Sheetal Ankolekar | Family Medicine | 625 Lincoln Ave, San Jose, CA 95126-3785 | 2013-07-03 |
| 1902145592 | Thanh-tam Ngoc Nguyen | Family Medicine | 625 Lincoln Ave, San Jose, CA 95126-3785 | 2013-02-03 |
| 1023360930 | Daniel Hudson Morgan | Family Medicine | 625 Lincoln Ave, San Jose, CA 95126-3785 | 2012-10-03 |
| 1326312067 | Verity Medical Foundation | Clinic/Center | 625 Lincoln Ave, San Jose, CA 95126-3705 | 2012-02-27 |
| 1053604652 | Hd Ultrasound, LLC | Clinic/Center | 625 Lincoln Ave, Suite 201, San Jose, CA 95126-3705 | 2011-05-16 |
| 1437469129 | Steven How-han Sheh | Internal Medicine | 625 Lincoln Ave, San Jose, CA 95126-3785 | 2010-10-14 |
| 1871658864 | Ruta V Wakharkar | Internal Medicine | 625 Lincoln Ave, San Jose, CA 95126-3785 | 2006-12-27 |
| 1598841215 | San Jose Medical Clinic, Inc. | Allergy & Immunology | 625 Lincoln Ave, San Jose, CA 95126-3705 | 2006-10-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356830418 | Esperanza Maravilla | Counselor | 1259 Park Ave, Apt 15, San Jose, CA 95126 | 2018-05-04 |
| 1811417819 | Sahr Lawande | Occupational Therapist | 1373 University Ave, San Jose, CA 95126 | 2017-06-21 |
| 1063941482 | Yang Li | Acupuncturist | 1520 Southwest Expy Unit 141, San Jose, CA 95126 | 2017-06-08 |
| 1598294860 | Camille Campbell | Counselor | 1400 Parkmoor Avenue, Suite 115, San Jose, CA 95126 | 2017-06-08 |
| 1588193387 | Vanessa Aspera | Case Manager/Care Coordinator | 1400 Parkmoor Avenue, San Jose, CA 95126 | 2017-06-06 |
| 1538692603 | Alexa Stine Fields | Acupuncturist | 714 Harding Ave, San Jose, CA 95126 | 2017-04-06 |
| 1669903647 | Lillette Rosete | Assisted Living Facility | 960 Vermont St, San Jose, CA 95126 | 2017-03-22 |
| 1952847105 | Dana Ninkham | Behavior Technician | 1922 The Alameda Suite 425, San Jose, CA 95126 | 2017-01-12 |
| 1811441199 | Cristina Morales Delgado | Community Health Worker | 1400 Parkmore Avenue, Suite 115, San Jose, CA 95126 | 2016-08-04 |
| 1053770123 | Felicia Nibungco | Marriage & Family Therapist | 1922 The Alameda Ste 326, San Jose, CA 95126 | 2016-02-18 |
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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.