NPI Record of PACIFIC NEUROSCIENCE MEDICAL GROUP, INC. (ENCEPHALOGIC MEDICAL GROUP, INC.) NPI 1144340662

Psychiatry & Neurology (Neurology) in Oxnard, CA

Complete NPI Record

Field Name Value Definition
NPI1144340662The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameENCEPHALOGIC MEDICAL GROUP, INC.The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NamePACIFIC NEUROSCIENCE MEDICAL GROUP, INC.Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address1701 SOLAR DRThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressSUITE 140The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameOXNARDThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameCAThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code930300134The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number8052784148The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number8052784634The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address1701 SOLAR DRThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSUITE 140The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameOXNARDThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameCAThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code930300134The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number8052784148The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number8052784634The fax number associated with the location address of the provider being identified.
Provider Enumeration Date3/29/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date8/1/2013The date that a record was last updated or changed.
Authorized Official Last NameSUTTONThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameJAMESThe first name of the authorized official.
Authorized Official Middle NameP.The middle name of the authorized official.
Authorized Official Title or PositionPRESIDENT - MEDICAL DIRECTORThe title or position of the authorized official.
Authorized Official Telephone Number8052784148The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1103G00000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 1CAThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1N
Healthcare Provider Taxonomy Code 22084N0400X
Provider License Number State Code 2CAThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2Y
Is Organization SubpartN
Authorized Official Name Prefix TextDR.
Authorized Official Credential TextM.D.
Healthcare Provider Taxonomy Group 1193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2193200000X MULTI-SPECIALTY GROUP