Larry I. Emdur, D.O., PHD.

Primary specialty

SpecialistTaxonomy code 174400000X

License

20A4940 Issued in CA

Legal business name

LARRY I. EMDUR, D.O., PHD.

Practice address

5555 Reservoir Dr
201
San Diego, CA 92120-5134

Phone

(619) 286-8803

Fax

(619) 286-2344

NPI assigned

Feb 9, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Larry I Emdur, D.O.NPI 1932109642

Title

President,Owner

Phone

(619) 286-8803

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Larry I Emdur, DO, PHD

  • Pulmonary Disease Physician
  • San Diego, CA
  • NPI 1932109642
  Medicare reassignment NPD Authorized official
• Gang Bao, M.D.

  • Pulmonary Disease Physician
  • San Diego, CA
  • NPI 1922008598
  NPD (past)
• Parvathi Tiruviluamala, MD

  • Specialist
  • San Diego, CA
  • NPI 1982798948
  NPD (past)

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344211200000",
    "number": "1326189671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5173 WARING RD",
            "address_2": "SUITE 125",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921202705",
            "telephone_number": "619-286-8803",
            "fax_number": "619-286-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 RESERVOIR DR",
            "address_2": "201",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205134",
            "telephone_number": "619-286-8803",
            "fax_number": "619-286-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY I. EMDUR, D.O., PHD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2012-08-06",
        "status": "A",
        "authorized_official_last_name": "EMDUR",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT,OWNER",
        "authorized_official_telephone_number": "619-286-8803",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "20A4940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CA;",
            "identifier": "GR0044140",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CA STATE LICENSE",
            "identifier": "20A4940",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel Larralde, M.D.
• Kristen Ryan Larrea, FNP-C
• Annie Ngo Larrow, M.D.
• Larry a Woznuk DDS Inc
• Larry Alenbaugh Optometry
• Daryl Larry-Sar, PHARMD
• Maiya Haruko Allegrezza Larry
• Anne Marie Larsen, PHD
• Camilyn Larsen, AMFT
• Derek Larsen, M.S., NCC

• Specialist in San Diego, CA
• Providers in San Diego, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.