Emmanuel P. Pentheroudakis, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

A75192 Issued in CA

Practice address

3626 Ruffin Rd
San Diego, CA 92123-1810

Phone

(858) 565-9666

Fax

(858) 565-9441

NPI assigned

Aug 1, 2006

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 2

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: epentheroudakis20823@scrippshlth.medalliesdirect.net

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.

• Anesthesia Service Medical Group

  • Anesthesiology Physician
  • San Diego, CA
  • NPI 1053354233
  Medicare reassignment NPD
• Scripps Health

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1487928891
  NPD

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196899200000",
    "number": "1114933652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3626 RUFFIN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231810",
            "telephone_number": "858-565-9666",
            "fax_number": "858-565-9441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3626 RUFFIN RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231810",
            "telephone_number": "858-565-9666",
            "fax_number": "858-565-9441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENTHEROUDAKIS",
        "first_name": "EMMANUEL",
        "middle_name": "P.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A75192",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A751920",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "00A751920",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carissa Lynn Pensack
• Kendra Penski, LCSW
• Jerrold Lee Penso, M.D.
• Michelle P Pent, MD
• Sarah Penteriani
• Sarah Penton
• Lily Penuelas
• Maria Fernanda Penunuri, DPT
• Norman Araby Peoples III
• Robin A Peoples

• Anesthesiology Physician in San Diego, CA
• Providers in San Diego, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.