Timothy R Donnelly, P.A.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA12169 Issued in CA

Practice address

1501 5TH Ave
Suite 100
San Diego, CA 92101-3291

Phone

(619) 461-3717

Fax

(619) 461-5663

NPI assigned

Sep 9, 2011

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Always There Mobile Physicians, Inc.

  • Internal Medicine Physician
  • La Mesa, CA
  • NPI 1780003251
  NPD (past)

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1538006400000",
    "number": "1083995609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12285 SCRIPPS POWAY PKWY",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920646149",
            "telephone_number": "951-708-6508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 5TH AVE",
            "address_2": "SUITE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921013291",
            "telephone_number": "619-461-3717",
            "fax_number": "619-461-5663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "TIMOTHY",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-09",
        "last_updated": "2018-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA12169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA LICENSE",
            "identifier": "PA12169",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lindsy Donnelly, ATHLETIC TRAINER
• Meaghan Lynn Donnelly, PA
• Megan Ruth Donnelly, M.A. COUNSELING PSY
• Robert Donnelly
• Sarah Donnelly
• Tracy Lynn Donnelly
• Miguel Angel Donneyz, MD
• Joy Joelle Donofrio-Odmann, D.O.
• Elizabeth T Donoghue, NP
• Katelynne Marie Donoghue

• Medical Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.