Individual provider Active NPI

Anthony Michael Proia, MD

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1376049411
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A164769 Issued in CA
Practice address
4650 Palm Ave
San Diego, CA 92154-8404
Phone
(833) 574-2273
NPI assigned
Apr 5, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X A164769 CA Primary

Addresses

Primary practice location

4650 Palm Ave
San Diego, CA 92154-8404

Mailing address

1267 Greenlake Dr
Cardiff by the Sea, CA 92007-1020
Phone (619) 457-3010

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

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
I20210610003360 CA Practitioner - Pediatric Medicine 1456751569 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A164769CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health CurrentSince Jun 14, 2021 Accepting new patients
Southern California Permanente Medical Group Multi-Specialty Current Accepting new patients
Scripps Health Multi-Specialty CurrentSince Jun 14, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 22, 2021 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Multi-Specialty CurrentSince Aug 23, 2021 Accepting new patients
Southern California Permanente Medical Group CurrentSince Dec 22, 2021 Accepting new patients
Sharp Rees-Stealy Medical Group, Inc Multi-Specialty CurrentSince Aug 23, 2021 Accepting new patients

Locations

9888 Genesee Ave
La Jolla, CA 92037
Phone (858) 457-4123

File 54433
Los Angeles, CA 90074
Phone (858) 784-5645

393 E Walnut St
Fl 3
Pasadena, CA 91188
Phone (626) 405-7914

15004 Innovation Dr
San Diego, CA 92128
Phone (858) 487-1800

4647 Zion Ave
San Diego, CA 92120
Phone (619) 528-3038

2020 Genesee Ave
San Diego, CA 92123
Phone (619) 268-9500

4650 Palm Ave
San Diego, CA 92154
Phone (619) 662-5226

8701 Cuyamaca St
Santee, CA 92071
Phone (619) 568-8025

Organizations & group practices 7

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": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1376049411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1267 GREENLAKE DR",
            "city": "CARDIFF BY THE SEA",
            "state": "CA",
            "postal_code": "920071020",
            "telephone_number": "619-457-3010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 PALM AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921548404",
            "telephone_number": "833-574-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROIA",
        "first_name": "ANTHONY",
        "middle_name": "MICHAEL",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-05",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A164769",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.