Bonebuilders Medical Clinic

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

G60659 Issued in CA

Legal business name

BONEBUILDERS MEDICAL CLINIC

Practice address

4150 Regents Park Row Ste 321
La Jolla, CA 92037-9124

Phone

(858) 678-0455

Fax

(858) 678-0391

NPI assigned

Dec 11, 2006

Last updated

Jan 7, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Charles N Rudolph, MDNPI 1386636348

Title

President

Phone

(858) 678-0455

Specialties & licenses 1

Addresses

Other identifiers 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 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles N Rudolph, MD

  • Orthopaedic Surgery Physician
  • La Jolla, CA
  • NPI 1386636348
  Authorized official Same address or phone

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641513600000",
    "number": "1356401566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 EXECUTIVE DRIVE",
            "address_2": "SUITE 125",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92121",
            "telephone_number": "858-678-0455",
            "fax_number": "858-678-0391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 REGENTS PARK ROW STE 321",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920379124",
            "telephone_number": "858-678-0455",
            "fax_number": "858-678-0391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONEBUILDERS MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2022-01-07",
        "certification_date": "2022-01-07",
        "status": "A",
        "authorized_official_last_name": "RUDOLPH",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "858-678-0455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "CA",
            "license": "G60659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1356401566",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Douglas Glynn Bolitho, M.D.
• Suresh Bollapragada
• Heather C. Bonaguidi, P.A.
• Robert A. Bonakdar, M.D.
• Kimberlee Ann Bond, OTR/L
• Jonvanni Bongolan
• Carly Alissa Bonnell, M.S.W.
• Claire Webb Bonnyman
• Beata Myrrha Booth, LAC
• Stephanie Borden, DPT

• Orthopaedic Surgery Physician in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Orthopaedic Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.