| Sd Sports Medicine And Family Health Center | |
|
6699 Alvarado Rd Ste 2100 San Diego CA 92120-5238 | |
| (619) 229-3909 | |
| (619) 229-3902 |
| Full Name | Sd Sports Medicine And Family Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 6699 Alvarado Rd, San Diego, California |
| Authorized Official Name and Position | Richard A. Parker (PRESIDENT / CEO) |
| Authorized Official Contact | 6192293909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sd Sports Medicine And Family Health Center 6699 Alvarado Rd Ste 2100 San Diego CA 92120-5238 Ph: (619) 229-3909 | Sd Sports Medicine And Family Health Center 6699 Alvarado Rd Ste 2100 San Diego CA 92120-5238 Ph: (619) 229-3909 |
| NPI Number | 1669472510 |
|---|---|
| Provider Enumeration Date | 07/21/2005 |
| Last Update Date | 10/03/2017 |
| Medicare PECOS PAC ID | 7113812496 |
|---|---|
| Medicare Enrollment ID | O20040315001639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669472510 | NPI | - | NPPES |
| GR0064940 | Medicaid | CA | |
| W12026 | Other | CA | GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Denise M Ohagan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1700019262 PECOS PAC ID: 4981699188 Enrollment ID: I20040416001525 |
| Provider Name | Chad M Neubrand |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699703207 PECOS PAC ID: 7315938636 Enrollment ID: I20040524000946 |
| Provider Name | Elizabeth Stelter |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1437181187 PECOS PAC ID: 8325086051 Enrollment ID: I20050421001455 |
| Provider Name | Douglas Dean Dengerink |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1598761413 PECOS PAC ID: 6800830217 Enrollment ID: I20050616000602 |
| Provider Name | Kenneth L Anderson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437172533 PECOS PAC ID: 4183652357 Enrollment ID: I20050728001187 |
| Provider Name | Wendy S Dengerink |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104822022 PECOS PAC ID: 4587645569 Enrollment ID: I20050923000410 |
| Provider Name | Shannon Kareen Walsh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1558472779 PECOS PAC ID: 7113925033 Enrollment ID: I20061130000559 |
| Provider Name | Doreen Hall |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1184644460 PECOS PAC ID: 2769481258 Enrollment ID: I20061211000446 |
| Provider Name | Kristen Manecke |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003066788 PECOS PAC ID: 5496816449 Enrollment ID: I20081209000379 |
| Provider Name | David E Larue |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932248630 PECOS PAC ID: 6204997950 Enrollment ID: I20081212000490 |
| Provider Name | Scott Randall Evans |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699894808 PECOS PAC ID: 8820150519 Enrollment ID: I20081213000250 |
| Provider Name | Stephen James Rohrer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821205873 PECOS PAC ID: 5092871749 Enrollment ID: I20090304000292 |
| Provider Name | Malina Styan |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1104150457 PECOS PAC ID: 8527100528 Enrollment ID: I20100128000256 |
| Provider Name | Theresa D Maloney |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649450016 PECOS PAC ID: 4789719626 Enrollment ID: I20100317000989 |
| Provider Name | Rebeccah R Rodriguez |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1922288802 PECOS PAC ID: 0749316859 Enrollment ID: I20100329000267 |
| Provider Name | Richard Allen Parker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982715348 PECOS PAC ID: 3971570870 Enrollment ID: I20110506000101 |
| Provider Name | Jeffrey Paul Anthony |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1376654632 PECOS PAC ID: 7517934417 Enrollment ID: I20110506000225 |
| Provider Name | Lee P Ralph |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1063523330 PECOS PAC ID: 3870560774 Enrollment ID: I20110506000439 |
| Provider Name | Frederick Allen Richburg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881798221 PECOS PAC ID: 4587860143 Enrollment ID: I20110509000250 |
| Provider Name | Michelle Lynn Look |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851402143 PECOS PAC ID: 2961688254 Enrollment ID: I20110523000176 |
| Provider Name | Emily Allina |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235403775 PECOS PAC ID: 9335300714 Enrollment ID: I20120411000494 |
| Provider Name | Sarah M Hare |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164864088 PECOS PAC ID: 6305074428 Enrollment ID: I20140118000164 |
| Provider Name | Kathryn C Spurrell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1134540586 PECOS PAC ID: 3375774219 Enrollment ID: I20140318001646 |
| Provider Name | Ana Luisa Elizondo |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1972776920 PECOS PAC ID: 8022237890 Enrollment ID: I20140910001803 |
| Provider Name | Alexandra Reed Myers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386922904 PECOS PAC ID: 8820217474 Enrollment ID: I20140929001056 |
| Provider Name | Joseph Mahon |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1013356005 PECOS PAC ID: 2668606807 Enrollment ID: I20150707002816 |
| Provider Name | Courtney N O'bryan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629414990 PECOS PAC ID: 4082905963 Enrollment ID: I20160817002359 |
| Provider Name | Nicholas L Schroeder |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679002372 PECOS PAC ID: 1052680725 Enrollment ID: I20170712001467 |
| Provider Name | Shawn Michael Renner |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1790283737 PECOS PAC ID: 1355602616 Enrollment ID: I20180228002956 |
| Provider Name | Andrew James Stewart |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1477962116 PECOS PAC ID: 3870713480 Enrollment ID: I20180622000179 |
| Provider Name | Elizabeth Ashley Williams- Drueding |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639589351 PECOS PAC ID: 4284904715 Enrollment ID: I20180904000624 |
| Provider Name | Jonathan A Koretoff |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346668779 PECOS PAC ID: 9335448182 Enrollment ID: I20180912003407 |
| Provider Name | Allison Mackenzie Allen |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1861972432 PECOS PAC ID: 2466705033 Enrollment ID: I20181029001276 |
| Provider Name | Rebecca Rios |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407371578 PECOS PAC ID: 5294071171 Enrollment ID: I20190114002825 |
| Provider Name | Katherine Uvelli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548607286 PECOS PAC ID: 3779803846 Enrollment ID: I20190129003555 |
| Provider Name | Benjamin A Vasko |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1801376975 PECOS PAC ID: 3173865615 Enrollment ID: I20190501003451 |
| Provider Name | Geoffrey K Lange |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952764052 PECOS PAC ID: 5294009064 Enrollment ID: I20191010001742 |
| Provider Name | Alex Michael Bernadett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1215382841 PECOS PAC ID: 2062797228 Enrollment ID: I20200727000159 |
| Provider Name | Tyler E. Adamson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295263002 PECOS PAC ID: 2567717671 Enrollment ID: I20200814001743 |
| Provider Name | Eric Wang |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083143820 PECOS PAC ID: 3375812175 Enrollment ID: I20210519001080 |
| Provider Name | Prachi Karande |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1699357525 PECOS PAC ID: 3476953811 Enrollment ID: I20210607002275 |
| Provider Name | Iman Akef Khowailed |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1457930489 PECOS PAC ID: 0547663387 Enrollment ID: I20210730001299 |
| Provider Name | Ashlee Smith |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427725035 PECOS PAC ID: 6204227366 Enrollment ID: I20211228000380 |
| Provider Name | Melissa Burman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1881198166 PECOS PAC ID: 3072866482 Enrollment ID: I20220328000325 |
| Provider Name | Nicholas Barin |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1003220385 PECOS PAC ID: 3476774035 Enrollment ID: I20220831000419 |
| Provider Name | Timothy Ryan Turner |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1295301299 PECOS PAC ID: 1557762606 Enrollment ID: I20220901002206 |
| Provider Name | Kelly Daniels Thomas |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1356074017 PECOS PAC ID: 2264800416 Enrollment ID: I20221121000905 |
| Provider Name | Mary Joyce Spring |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174209266 PECOS PAC ID: 9739540618 Enrollment ID: I20230726000619 |
| Provider Name | Patrick James Ryan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871080606 PECOS PAC ID: 7012243207 Enrollment ID: I20230802001841 |
| Provider Name | Janae Alyse Anthony |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1366210791 PECOS PAC ID: 3779936109 Enrollment ID: I20240201000802 |
Revivify Restorative Medicine Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 16445 Bernardo Center Dr, San Diego, CA 92128 Phone: 858-429-0099 Fax: 858-676-1172 | |
Nucleus Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4570 Executive Dr Ste 100, San Diego, CA 92121 Phone: 844-838-3322 | |
Moden Medical Group Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 8901 Activity Rd Ste 205, San Diego, CA 92126 Phone: 888-822-1184 Fax: 888-877-3676 | |
Aldiwani Medical Group Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 11409 Windy Summit Pl, San Diego, CA 92127 Phone: 832-371-3279 Fax: 619-939-4556 | |
Presidio Medical Group Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4440 Lamont St, San Diego, CA 92109 Phone: 858-270-7633 Fax: 858-270-7692 | |
Michael L Butera Md Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 6699 Alvarado Rd Ste 2309, San Diego, CA 92120 Phone: 619-286-8803 Fax: 619-286-2344 | |
San Diego Digestive Disease Consultants, Inc. A Medical Group Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8008 Frost St, Ste 200, San Diego, CA 92123 Phone: 858-292-7527 Fax: 858-292-7804 |