OrganizationBristol Park Medical Group, IncFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address722 Baker St, Costa Mesa, CA 92626-4320(714) 557-6300(714) 665-1600PECOS EnrollmentBased on the most recent information from CMS, provider Bristol Park Medical Group, Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1043266760Provider TypeOrganizationFull NameBristol Park Medical Group, IncSubpartNoEnumeration Date5/25/2006Last Updated10/15/2008Contact InformationPractice LocationPractice Address722 Baker St, Costa Mesa, CA 92626-4320Phone(714) 557-6300Fax(714) 966-9567Mailing LocationMailing Address2742 Dow Ave, Tustin, CA 92780-7242Phone(714) 665-1600FaxUnlisted FaxAuthorized OfficialNameSchafer, Mark D (Medical Director)Phone(714) 665-1661Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode207R00000XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode208000000XDescriptionPediatricsAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode332B00000XDescriptionDurable Medical Equipment & Medical SuppliesSuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerIDGR0069199DescriptionMedicaidIssuerUnlistedCalifornia