NPIMap

Individual provider Active NPI

Richard K. Petyn, M.D.

  • Internal Medicine Physician
  • Oceanside, CA
National Provider Identifier
1376625004
Registry record updated Aug 12, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A51659 Issued in CA
Practice address
4318 Mission Ave
Oceanside, CA 92057-6541
Phone
(760) 901-5060
Fax
(760) 722-2204
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A51659 CA Primary

Addresses

Primary practice location

4318 Mission Ave
Oceanside, CA 92057-6541

Mailing address

4318 Mission Ave
Oceanside, CA 92057-6541
Phone (760) 901-5060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031210001188 CA Practitioner - Internal Medicine 3779489679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

4318 Mission Ave
Oceanside, CA 92057-6541
Phone (760) 901-5100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions59

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A51659CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Internal Medicine CurrentSince Aug 1, 2008 Accepting new patients
Scripps Health CurrentSince Aug 1, 2008 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Internal Medicine Current Accepting new patients
Scripps Health Internal Medicine Past Accepting new patients
Scripps Health Past Accepting new patients
Tri-City Hospital Past 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

2205 Vista Way
Ste 310
Oceanside, CA 92054

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

Interoperability endpoints

  • Direct secure messaging: rpetyn18873@scrippshlth.medalliesdirect.net

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.

Hospital & facility affiliations 6

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": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376265600000",
    "number": "1376625004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4318 MISSION AVE",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920576541",
            "telephone_number": "760-901-5060",
            "fax_number": "760-722-2204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4318 MISSION AVE",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "920576541",
            "telephone_number": "760-901-5060",
            "fax_number": "760-722-2204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETYN",
        "first_name": "RICHARD",
        "middle_name": "K.",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2013-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A51659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, CA

Sources for this page

Verify at the official NPI Registry.