Individual provider Active NPI

Kenneth Grudko, M.D.

  • Pulmonary Disease Physician
  • La Jolla, CA
National Provider Identifier
1164522199
Registry record updated Jun 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
G80633 Issued in CA
Practice address
10666 N Torrey Pines Rd
La Jolla, CA 92037-1027
Phone
(858) 554-8860
NPI assigned
Sep 22, 2006
Last updated
Jun 25, 2009By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X G80633 CA Primary

Addresses

Primary practice location

10666 N Torrey Pines Rd
La Jolla, CA 92037-1027

Mailing address

54433 File
Los Angeles, CA 90074-0001

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100524000449 CA Practitioner - Pulmonary DiseasePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists) 0941339352 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

10666 N Torrey Pines Rd
La Jolla, CA 92037-1027
Phone (858) 554-9100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G80633CAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Jun 1, 2013 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Jun 1, 2013 Accepting new patients
Scripps Clinic Medical Group, Inc Past Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients

Locations

10666 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-2626

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

3811 Valley Centre Dr
San Diego, CA 92130
Phone (858) 554-8645

9730 Summers Ridge Rd
#100
San Diego, CA 92121
Phone (858) 549-7400

Interoperability endpoints

  • Direct secure messaging: kgrudko7929@scrippshlth.medalliesdirect.net

Organizations & group practices 8

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

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245888000000",
    "number": "1164522199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54433 FILE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900740001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10666 N TORREY PINES RD",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371027",
            "telephone_number": "858-554-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUDKO",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-22",
        "last_updated": "2009-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "CA",
            "license": "G80633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.