BRISTOL PARK MEDICAL GROUP, INC (NPI# 1548348113) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548348113 |
| Entity Type | Organization |
| Organization Name | BRISTOL PARK MEDICAL GROUP, INC |
| Practice Address |
2742 Dow Ave Tustin CA 92780-7242 |
| Practice Telephone | 7146651661 |
| Practice Fax Number | 7146651669 |
| Mailing Telephone | 7146651600 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-10-15 |
| Authorized Official Name | DR. MARK D SCHAFER (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 7146651661 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| Y | 302F00000X | Exclusive Provider Organization | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | GR0069196 | 05 | |
| CA | GR0069197 | 05 | |
| CA | GR006919G | 05 | |
| CA | GR0069194 | 05 | |
| CA | GR006919H | 05 | |
| CA | GR0069190 | 05 | |
| CA | GR006919B | 05 | |
| CA | GR006919J | 05 | |
| CA | GR0069198 | 05 | |
| CA | GR0069199 | 05 | |
| CA | GR006919A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063469229 | Bristol Park Medical Group, Inc | Internal Medicine | 26991 Crown Valley Pkwy, Mission Viejo, CA 92691-6528 | 2006-05-31 |
| 1386691004 | Bristol Park Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 250 E Yale Loop, Suite 200, Irvine, CA 92604-4697 | 2006-05-28 |
| 1427005180 | Bristol Park Medical Group, Inc | Internal Medicine | 3010 W Orange Ave, Anaheim, CA 92804-3172 | 2006-05-28 |
| 1689621260 | Bristol Park Medical Group, Inc | Internal Medicine | 11420 Warner Ave, Fountain Valley, CA 92708-2529 | 2006-05-28 |
| 1437105509 | Bristol Park Medical Group, Inc | Pediatrics | 15 Mareblu, Suite 100, Aliso Viejo, CA 92656-3015 | 2006-05-26 |
| 1043266760 | Bristol Park Medical Group, Inc | Durable Medical Equipment & Medical Supplies | 722 Baker St, Costa Mesa, CA 92626-4320 | 2006-05-25 |
| Street Address |
2742 DOW AVE |
| City | TUSTIN |
| State | CA |
| Zip Code | 92780-7242 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417948894 | Mark D Schafer | Internal Medicine | 2742 Dow Ave, Tustin, CA 92780-7242 | 2005-11-03 |
| 1508195231 | Amanda M Imai | Nurse Practitioner | 2742 Dow Ave, Tustin, CA 92780-7242 | 2009-12-08 |
| 1629284971 | Elizabeth Tsai | Internal Medicine | 2742 Dow Ave, Tustin, CA 92780-7242 | 2007-05-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437780947 | John Michael Michael | Pharmacist | 14481 Wildeve Ln, Tustin, CA 92780 | 2020-02-03 |
| 1609426881 | Abigail Joy Maqsood | Behavior Technician | 290a S Prospect Ave, Tustin, CA 92780 | 2019-09-19 |
| 1255814711 | Hyun Dong Lee | Chiropractor | 14591 Newport Ave Ste 106, Tustin, CA 92780 | 2018-09-11 |
| 1346733573 | Elizabeth Kim Nguyen Dds Inc | Clinic/Center | 14521 Red Hill Ave, Tustin, CA 92780 | 2018-06-12 |
| 1255829503 | Hw Physical Therapy | Physical Therapist | 250 El Camino Real Ste 100, Tustin, CA 92780 | 2018-04-23 |
| 1912494352 | Gary Wayne Mcbeath | Marriage & Family Therapist | 17821 E 17th Street, Suite # 260, Tustin, CA 92780 | 2018-04-20 |
| 1104334598 | Catherine Bogues | Speech-Language Pathologist | 661 West 1st Street, Suite E, Tustin, CA 92780 | 2018-01-19 |
| 1972019941 | Lighthouse Behavioral Solutions | Behavioral Analyst | 18002 Irvine Blvd., Suite 202c, Tustin, CA 92780 | 2017-12-28 |
| 1629597299 | Lifecab, LLC | Non-emergency Medical Transport (VAN) | 13732 Newport Ave, Suite #1, Tustin, CA 92780 | 2017-09-14 |
| 1437606555 | Tustin Speech Therapy, Inc. | Speech-Language Pathologist | 661 West First Street, Suite E, Tustin, CA 92780 | 2016-09-07 |
| Find all providers in zip 92780 | ||||
| Taxonomy Code | 302F00000X |
| Grouping | Managed Care Organizations |
| Classification | Exclusive Provider Organization |
| (1) An EPO is a form of PPO, in which patients must visit a caregiver that is specified on its panel of providers (is a participating provider). If a visit to an outside(not participating) provider is made the EPO offers very limited or no coverage for the medical service; (2) While similar to a PPO in that an EPO allows patients to go outside the network for care, if they do so in an EPO, they are required to pay the entire cost of care. An EPO differs from an HMO in that EPO physicians do not receive capitation but instead are reimbursed only for actual services provided; (3) An organization identical to a preferred provider organization except that persons enrolled in the plan are eligible to receive benefits only when they use the services of the contracting providers. No benefits are available when non-contracting providers are used, except in certain emergency situations. |
| 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. 15; (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; (3) Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003004268 | Alexander I. Zamanian,m.d. Inc.a Professional Corporation | Exclusive Provider Organization | 14642 Newport Ave, Suite 310, Tustin, CA 92780-6057 | 2007-10-11 |
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| 1922586114 | Primary Care Associates of California of San Diego, Inc. | Exclusive Provider Organization | 10833 Valley View St Ste 570, Cypress, CA 90630-5061 | 2018-07-31 |
| 1962949057 | Sol Play Child Therapy Inc | Exclusive Provider Organization | 5811 Amaya Dr Ste 204, La Mesa, CA 91942-4156 | 2017-01-26 |
| 1841735511 | E.moawad Dental Corporation | Exclusive Provider Organization | 402 S Long Beach Blvd, Compton, CA 90221-3428 | 2017-01-04 |
| 1538512744 | Azila Katherine Sabile Ortiz | Exclusive Provider Organization | 15260 Amalia St, San Diego, CA 92129-1228 | 2016-07-22 |
| 1730534330 | Northern California Physicians Network Inc | Exclusive Provider Organization | 2331 Montpelier Dr, San Jose, CA 95116-1688 | 2016-05-02 |
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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.