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Megan C Demott

Emergency Medicine

Allopathic & Osteopathic Physicians

5984 La Jolla Corona Dr, La Jolla, CA 92037-7447

PECOS Enrollment

This provider is enrolled in PECOS as MEGAN DEMOTT.

Based on the most recent information from CMS, provider Megan C Demott is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:51 AM.

Profile Details

Provider ID
1174507370
Provider Type
Individual
Full Name
Demott, Megan C
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
12/1/2005
Last Updated
12/9/2011

Contact Information

Practice Location

5984 La Jolla Corona Dr, La Jolla, CA 92037-7447

(503) 490-8067

Unlisted Fax

Mailing Location

5984 La Jolla Corona Dr, La Jolla, CA 92037-7447

(503) 490-8067

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207P00000X Primary	Description Emergency Medicine Allopathic & Osteopathic Physicians	License A96269 California

Provider Identifiers

ID	Description	Issuer
ID 00A962690	Description Medicaid	Issuer Unlisted California
ID 1174507370	Description Medicaid	Issuer Unlisted California

Megan C Demott

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Reilly, Ian

Villani, Heather Renee

Kozak, Thomas

Hare, Marc A

Tresenriter, Megan

Edwin Iliff, M.D.,Inc.

Henderson, Steven E

Patel, Raj J

Neuendorf, Johannes M.

La Jolla Emergency Specialists