GEORGE GREGORY SUPER (NPI# 1790748507) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790748507 |
| Entity Type | Individual |
| Full Name | GEORGE GREGORY SUPER |
| Other Name | GREG SUPER |
| Credential | M.D. |
| Practice Address |
One Hoag Dr Ecu Dept Newport Beach CA 92663-4162 |
| Mailing Address |
Po Box 720300 Oklahoma City OK 73172-0300 |
| Practice Telephone | 9497645689 |
| Practice Fax Number | 4057513183 |
| Mailing Telephone | 8007494560 |
| Mailing Fax Number | 4057513181 |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2012-09-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | C32629 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00C326290 | 05 | |
| CA | BLUE SHIELD | 00C326290 | 01 |
| CA | 00C326290670 | 05 | |
| CA | RR MEDICARE | P00242844 | 01 |
| Street Address |
ONE HOAG DR ECU DEPT |
| City | NEWPORT BEACH |
| State | CA |
| Zip Code | 92663-4162 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891758686 | William James Green | Emergency Medicine | One Hoag Dr, Ecu Dept., Newport Beach, CA 92658-6100 | 2006-04-11 |
| 1679598817 | Steven Lin | Internal Medicine | One Hoag Dr, Newport Beach, CA 92663-4162 | 2006-07-12 |
| 1922062892 | David Gregg Meyers | Emergency Medicine | One Hoag Dr, Ecu Dept., Newport Beach, CA 92663-4162 | 2006-04-17 |
| 1144284001 | Howard Ken Nakashioya | Emergency Medicine | One Hoag Dr, Ecu Dept, Newport Beach, CA 92663-4162 | 2006-04-17 |
| 1215991252 | Raymond Louis Ricci | Emergency Medicine | One Hoag Dr, Ecu Dept, Newport Beach, CA 92663-4162 | 2006-04-14 |
| 1578526356 | Darrin Miles Fryer | Emergency Medicine | One Hoag Dr, Ecu Dept., Newport Beach, CA 92663-4162 | 2006-04-11 |
| 1164485967 | Pascal S.c. Juang | Emergency Medicine | One Hoag Dr, Ecu Dept, Newport Beach, CA 92663-4162 | 2006-04-11 |
| 1710940549 | Robert Graham Mccormick | Emergency Medicine | One Hoag Dr, Ecu Dept, Newport Beach, CA 92663-4162 | 2006-04-11 |
| 1629031455 | William Park | Emergency Medicine | One Hoag Dr, Ecu Dept, Newport Beach, CA 92663-4162 | 2006-04-11 |
| 1932162724 | Brian Jeffrey Grade | Emergency Medicine | One Hoag Dr, Ecu Dept., Newport Beach, CA 92663-4162 | 2006-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851905483 | Oasis Anesthesia, Surgical and Medical Group, Inc | Anesthesiology | 496 Old Newpor Blvd., Suite 2, Newport Beach, CA 92663 | 2020-09-01 |
| 1699232801 | Megan Gregor | Surgery | One Hoag Dr., Bldg 41, Ste 122, Newport Beach, CA 92663 | 2019-02-24 |
| 1831621382 | Narges Maududi | Social Worker | 1965 Sherrington Place, K111, Newport Beach, CA 92663 | 2017-04-03 |
| 1225495153 | Mitchelle Giorgi | Physical Therapist | 351 Hospital Road, Suite 007, Newport Beach, CA 92663 | 2016-01-22 |
| 1043620057 | Leslie Mccormack | Speech-Language Pathologist | 270 Cagney Lane #101, Newport Beach, CA 92663 | 2014-04-29 |
| 1265867162 | Hotel California By The Sea, LLC | Substance Abuse Rehabilitation Facility | 4504 Seashore Drive, Newport Beach, CA 92663 | 2013-09-10 |
| 1538504733 | Shawn Zardouz | Psychiatry & Neurology | 3900 W Coast Hwy Ste 390, Newport Beach, CA 92663 | 2013-05-02 |
| 1326330119 | Denise Fortenberry Fortenberry-gratias | Nurse Practitioner | 520 Superior Ave, Suite 350, Newport Beach, CA 92663 | 2011-05-11 |
| 1043500390 | Romit Kumar Kar | Pediatrics | 355 Placentia Ave Ste 301, Newport Beach, CA 92663 | 2011-04-07 |
| 1477858546 | Newport Neurohospitalists | Neurological Surgery | 510 Superior Ave Ste 280, Newport Beach, CA 92663 | 2011-01-20 |
| Find all providers in zip 92663 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891144580 | Tiffany Lynn Mathias | Emergency Medicine | 441 Old Newport Blvd, Newport Beach, CA 92663-4233 | 2016-06-03 |
| 1427384940 | Edward Charles Geehr | Emergency Medicine | 703 Saint James Pl, Newport Beach, CA 92663-5834 | 2009-10-19 |
| 1346405842 | Bella Kochuveli | Emergency Medicine | 100 Vilaggio, Newport Beach, CA 92660-9021 | 2008-07-23 |
| 1619273018 | Heather Ann Marino | Emergency Medicine | 400 Newport Center Dr, Suite 408, Newport Beach, CA 92660-7601 | 2011-02-02 |
| 1952622417 | Eugene Sun Yim | Emergency Medicine | 22 Corporate Plaza Dr, Newport Beach, CA 92660 | 2010-06-18 |
| 1386818482 | Larry D Pham | Emergency Medicine | 1 Hoag Dr, Newport Beach, CA 92663-4162 | 2008-04-18 |
| 1457409476 | Benjamin Kim-wakamatsu | Emergency Medicine | 1 Hoag Drive, Newport Beach, CA 92658-6100 | 2007-01-08 |
| 1689686909 | Kenneth S Cheng | Emergency Medicine | 17 Corporate Plaza Dr, Suite 110, Newport Beach, CA 92660-7902 | 2006-08-13 |
| 1356306831 | William Hawley Cloud | Emergency Medicine | One Hoag Drive, Ecu Dept., Newport Beach, CA 92663-4162 | 2006-04-19 |
| 1922062892 | David Gregg Meyers | Emergency Medicine | One Hoag Dr, Ecu Dept., Newport Beach, CA 92663-4162 | 2006-04-17 |
| Find all providers in NEWPORT BEACH | ||||
| City | NEWPORT BEACH |
| Zip Code | 92663 |
Please comment or provide details below to improve the information on GEORGE GREGORY SUPER.
| 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.