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SAN DIEGO MEDICAL GROUP
NPI 1043383144
Internal Medicine in San Diego, CA

Active since November 16, 2006CLIA 05D0930584 · Waiver
4060 FOURTH AVE, SUITE 100, SAN DIEGO, CA 92103(619) 718-9444(619) 718-9440 Get Directions Write a Review

NPPES record last updated: November 14, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About San Diego Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAN DIEGO MEDICAL GROUP (NPI 1043383144) is a healthcare organization registered as an internal medicine in San Diego, California and active in the NPI registry since November 2006. The organization holds a CLIA Waiver certificate valid through July 14, 2027 and lists Connie Johnson, Office Mgr, as its authorized official.

NPPES Registry Identity

NPI1043383144
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NamePAUL D WAGNER M D INC
Location Address4060 FOURTH AVE, SUITE 100San Diego, CA 92103-2120
Mailing Address4060 Fourth Ave, Suite 100San Diego, CA 92103-2120 · (619) 718-9444 · Fax (619) 718-9440
Phone(619) 718-9444
Fax(619) 718-9440
Organization SubpartNo
Authorized OfficialConnie JohnsonOffice Mgr · (619) 718-9444
Enumeration DateNovember 16, 2006
Last NPPES UpdateNovember 14, 2022
NPPES CertifiedNovember 14, 2022
✔ NPI 1043383144 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License✔ Licensed in CA · G77188
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
4060 FOURTH AVE, San Diego, CA 92103
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Other Names 1

Doing Business AsSan Diego Medical Group

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0930584

San Diego Medical Group · San Diego, CA
Active · expires Jul 14, 2027
CLIA Number05D0930584
Laboratory TypePhysician Office
Certificate Effective DateJuly 15, 2025
Certificate Expiration DateJuly 14, 2027
Laboratory DirectorPaul D. Wagner
Laboratory Phone(951) 676-4193
Laboratory LocationSan Diego Medical Group4060 Fourth Ave Suite 100, San Diego, CA 92103
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BS KHEHAR MD INC
Internal Medicine
4060 FOURTH AVE, SUITE 335
SAN DIEGO, CA 92103
San Diego County (619) 291-9285
JEFFREY ROBERT TOMAN M.D.
Colon & Rectal Surgery
4060 FOURTH AVE, SUITE 510
SAN DIEGO, CA 92103
San Diego County (619) 686-4011
MICHAEL J. NELMS PA-C
Physician Assistant
4060 FOURTH AVE, SUITE 415
SAN DIEGO, CA 92103
San Diego County (619) 298-9809
MELISSA JANOVITCH P.A.
Physician Assistant (Medical)
4060 FOURTH AVE, SUITE 415
SAN DIEGO, CA 92103
San Diego County (619) 298-9809
JERROLD GLASSMAN M.D.
Internal Medicine (Cardiovascular Disease)
4060 FOURTH AVE, SUITE 650
SAN DIEGO, CA 92103
San Diego County (619) 819-7222
MS. ARACELI ESTRADA-ORTEGA RDN, CDN
Dietitian, Registered
4060 FOURTH AVE
SAN DIEGO, CA 92103
San Diego County (619) 298-9931
DR. KAREN HERBST JAMISON M.D.
Internal Medicine
4060 FOURTH AVE, SUITE 505
SAN DIEGO, CA 92103
San Diego County (619) 298-1318
ZHIKE PRUETT N.P.
Nurse Practitioner
4060 FOURTH AVE, SUITE 220
SAN DIEGO, CA 92103
San Diego County (866) 284-2771

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Paul D Wagner M D Inc's NPI number?

The NPI number for Paul D Wagner M D Inc is 1043383144. It was assigned to this organization in the NPPES registry on November 16, 2006. The provider is doing business as San Diego Medical Group.

Where is Paul D Wagner M D Inc located?

Paul D Wagner M D Inc is located at 4060 Fourth Ave Suite 100, San Diego, CA 92103. The listed phone number is (619) 718-9444.

What is Paul D Wagner M D Inc's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Does Paul D Wagner M D Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0930584) is associated with this NPI, valid through July 14, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Paul D Wagner M D Inc was last updated on November 14, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.