Individual provider Active NPI

Jonathan Allen Koretoff, M.D.

  • Sports Medicine (Family Medicine) Physician
  • San Diego, CA
National Provider Identifier
1346668779
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X
License
A157665 Issued in CA
Practice address
10505 Sorrento Valley Rd Ste 200
San Diego, CA 92121-1619
Phone
(858) 793-7860
NPI assigned
Apr 2, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Family Medicine) Physician 207QS0010X A157665 CA Primary

Addresses

Primary practice location

10505 Sorrento Valley Rd Ste 200
San Diego, CA 92121-1619

Mailing address

10505 Sorrento Valley Rd Ste 200
San Diego, CA 92121-1619
Phone (858) 793-7860

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
I20180912003407 CA Practitioner - Family PracticePractitioner - Sports Medicine 9335448182 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
SD Sports Medicine and Family Health CenterGroup PAC ID 7113812496, 38 clinicians

Practice addresses (Care Compare)

6699 Alvarado Rd
Suite 2100
San Diego, CA 92120-5238
Phone (619) 229-3909

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025

Merit-based Incentive Payment System (MIPS)

Final score
90.4 of 100Reported as group
Quality
93.75
Promoting interoperability
100
Improvement activities
40
Cost
74.23

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A157665CAMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Primary Care Sports Medicine a Medical Corporation Sports Medicine CurrentSince Aug 20, 2018 Accepting new patients
Primary Care Sports Medicine a Medical Corporation Sports Medicine CurrentSince Aug 20, 2018 Accepting new patients
SD Sports Medicine and Family Health Center CurrentSince Jan 3, 2023 Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Past Accepting new patients

Locations

10505 Sorrento Valley Rd
Ste 200
San Diego, CA 92121
Phone (858) 793-7860

6699 Alvarado Rd
Ste 2100
San Diego, CA 92120
Phone (619) 229-3909

1945 Garnet Ave
San Diego, CA 92109
Phone (858) 224-7977

18411 Clark St
Ste 302
Tarzana, CA 91356
Phone (818) 501-7276

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1396396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1346668779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10505 SORRENTO VALLEY RD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211619",
            "telephone_number": "858-793-7860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10505 SORRENTO VALLEY RD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211619",
            "telephone_number": "858-793-7860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORETOFF",
        "first_name": "JONATHAN",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-04-02",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "CA",
            "license": "A157665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.