Active NPI
Marc Alain Durocher, MD
- Pediatrics Physician
- San Diego, CA
National Provider Identifier
1124778006
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- PTL9770
- Practice address
- 3020 Childrens Way # Mc5124
San Diego, CA 92123-4223 - Phone
- (858) 966-6764
- NPI assigned
- Mar 24, 2022
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | PTL9770 | CA | Primary |
Addresses
Primary practice location
3020 Childrens Way # Mc5124
San Diego, CA 92123-4223
Mailing address
3020 Childrens Way # Mc5124
San Diego, CA 92123-4223
Phone (858) 966-6764
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: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250506003212 | CA | Order and Referring Only - Pediatric Medicine | 2769909464 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTL9770 | CA | MD | Pediatrics Physician |
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677801600000",
"number": "1124778006",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3020 CHILDRENS WAY # MC5124",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234223",
"telephone_number": "858-966-6764"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3020 CHILDRENS WAY # MC5124",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921234223",
"telephone_number": "858-966-6764"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUROCHER",
"first_name": "MARC",
"middle_name": "ALAIN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-03-24",
"last_updated": "2023-03-03",
"certification_date": "2023-03-03",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "PTL9770",
"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 Mar 3, 2023; 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.