Active NPI
Justin James Judilla, PA-C
- Physician Assistant
- San Diego, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 64059
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Enrollment records 1
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 64059 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sharp Rees-Stealy Medical Group, Inc | Current | Accepting new patients | |
| Sharp Rees-Stealy Medical Group, Inc | Physician Assistant | Current | 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.
-
- Internal Medicine Physician
- San Diego, CA
- NPI 1285616177
Physician Assistant
-
- Optometrist
- San Diego, CA
- NPI 1063172351
-
- Physical Therapist
- Chula Vista, CA
- NPI 1407096589
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.