Active NPI
Chad David Mediate, D.P.T.
- Physical Therapist
- La Jolla, CA
National Provider Identifier
1265702807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 37003
- Practice address
- 4130 La Jolla Village Dr
Suite 306
La Jolla, CA 92037-9121 - Phone
- (858) 455-6460
- NPI assigned
- Jan 12, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 37003 | CA | Primary |
| Physical Therapist | 225100000X | 012196 | OH |
Addresses
Primary practice location
4130 La Jolla Village Dr
Suite 306
La Jolla, CA 92037-9121
Mailing address
3651 1/2 Arnold Ave
1/2
San Diego, CA 92104-3441
Phone (216) 272-0558
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 012196 | OH | MD | Physical Therapist |
| 37003 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Girard Orthopaedic Surgeons Medical Group,. Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Specialist
- San Diego, CA
- NPI 1962438564
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326326400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326326400000",
"number": "1265702807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3651 1/2 ARNOLD AVE",
"address_2": "1/2",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921043441",
"telephone_number": "216-272-0558"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4130 LA JOLLA VILLAGE DR",
"address_2": "SUITE 306",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920379121",
"telephone_number": "858-455-6460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDIATE",
"first_name": "CHAD",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-01-12",
"last_updated": "2012-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "37003",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OH",
"license": "012196",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.