Look up the most recent NPI and PECOS records

Gastric Banding Medical Group

Specialist

Other Service Providers

8705 Complex Dr, San Diego, CA 92123-1401

PECOS Enrollment

Based on the most recent information from CMS, provider Gastric Banding Medical Group does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1518335710
Provider Type
Organization
Full Name
Gastric Banding Medical Group

Subpart
No
Enumeration Date
9/4/2015
Last Updated
9/4/2015

Contact Information

Practice Location

8705 Complex Dr, San Diego, CA 92123-1401

(858) 715-1822

(858) 974-7245

Mailing Location

8705 Complex Dr, San Diego, CA 92123-1401

(858) 715-1822

(858) 974-7245

Authorized Official

Gertsch, Ronald Leroy (Medical Director)

(858) 715-1822

Provider Taxonomies

Code	Description	License
Code 174400000X Primary	Description Specialist Other Service Providers	License C35744 California

Gastric Banding Medical Group

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Authorized Official

Provider Taxonomies

Code

Description

License

Code

Description

License

Hearne, Traci

Keith A Jackson Md Limited

Radiation Medical Group

Jean-Jacques Abitbol M D A Medical Corporation

Thomas W. Harris Md Inc

Sami N. Maywood, M.D., Inc

Martin, Bianca

Ocampo, Annie Fabiola

Wixom, Christopher Rich

Thompson, Patricia Yvonne