Individual provider Active NPI

Charles Kasmir Jablecki, M.D.

  • Neurology Physician
  • San Diego, CA
National Provider Identifier
1255315677
Registry record updated Oct 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
G33067 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(858) 657-8540
NPI assigned
Nov 30, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X G33067 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

8677 Villa la Jolla Dr # 215
La Jolla, CA 92037-2354
Phone (619) 296-1234

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
I20100909000592 CA Practitioner - Neurology 6103941588 Reassigns benefits to 1 organization
Practice locations: La Jolla, CA

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G33067CAMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Current Accepting new patients
Regents of the University of California Neurology CurrentSince Dec 27, 2014 Accepting new patients
Regents of the University of California CurrentSince Dec 27, 2014 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California Current Accepting new patients
Sharp Memorial Hospital Past Accepting new patients
Rady Children's Hospital San Diego Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

6655 Alvarado Rd
San Diego, CA 92120
Phone (619) 229-3130

4510 Executive Dr
San Diego, CA 92121
Phone (858) 450-5000

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

4250 1st Ave
San Diego, CA 92103
Phone (415) 290-8175

4510 Executive Dr
Ste 201
San Diego, CA 92121
Phone (858) 457-7994

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540857600000",
    "number": "1255315677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8677 VILLA LA JOLLA DR # 215",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920372354",
            "telephone_number": "619-296-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "858-657-8540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JABLECKI",
        "first_name": "CHARLES",
        "middle_name": "KASMIR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2018-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "G33067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.