Individual provider Active NPI

Justin James Judilla, PA-C

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1043074438
Registry record updated Jun 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
64059 Issued in CA
Practice address
5651 Copley Dr
San Diego, CA 92111-7903
Phone
(858) 541-5400
NPI assigned
Feb 7, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 7, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 64059 CA Primary

Addresses

Primary practice location

5651 Copley Dr
San Diego, CA 92111-7903

Mailing address

5651 Copley Dr
San Diego, CA 92111-7903
Phone (858) 541-5400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240529004098 CA Practitioner - Physician Assistant 9133561632 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sharp Rees-Stealy Medical Group IncGroup PAC ID 8628972759, 872 clinicians

Practice addresses (Care Compare)

2929 Health Ctr Dr
San Diego, CA 92123-2762
Phone (858) 499-2600

3075 Health Ctr Dr
Suite 401
San Diego, CA 92123-2773
Phone (858) 499-2600

344 F St
Suite 300
Chula Vista, CA 91910-2647
Phone (619) 585-4080

480 H St
Chula Vista, CA 91910-4328
Phone (858) 499-2600

8008 Frost St
Suite 106
San Diego, CA 92123-4229
Phone (858) 499-2600

8010 Frost St
FL 2
San Diego, CA 92123-4284
Phone (858) 499-2600

8975 Balboa Ave
San Diego, CA 92123-1507
Phone (858) 499-2600

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
64059CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Rees-Stealy Medical Group, Inc CurrentSince Apr 8, 2024 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Physician Assistant CurrentSince Apr 8, 2024 Accepting new patients
Sharp Rees-Stealy Medical Center Past Accepting new patients

Locations

525 Third Ave
Chula Vista, CA 91910
Phone (619) 585-4050

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

5651 Copley Dr
San Diego, CA 92111
Phone (858) 262-6340

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717718400000",
    "number": "1043074438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5651 COPLEY DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117903",
            "telephone_number": "858-541-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5651 COPLEY DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117903",
            "telephone_number": "858-541-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUDILLA",
        "first_name": "JUSTIN",
        "middle_name": "JAMES",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-02-07",
        "last_updated": "2024-06-07",
        "certification_date": "2024-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "64059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.