Individual provider Active NPI

Kathleen D Rusk, PA

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1376654699
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13657 Issued in CA
Practice address
6699 Alvarado Rd
Suite 2100
San Diego, CA 92120-5238
Phone
(619) 229-3909
Fax
(619) 582-1497
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13657 CA Primary

Addresses

Primary practice location

6699 Alvarado Rd
Suite 2100
San Diego, CA 92120-5238

Mailing address

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

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140917000339 CA Practitioner - Physician Assistant 6204055668 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
13657CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Past Accepting new patients

Organizations & group practices 3

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1376654699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6699 ALVARADO RD",
            "address_2": "SUITE 2100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205238",
            "telephone_number": "619-229-3909",
            "fax_number": "619-582-1497"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6699 ALVARADO RD",
            "address_2": "SUITE 2100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921205238",
            "telephone_number": "619-229-3909",
            "fax_number": "619-582-1497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUSK",
        "first_name": "KATHLEEN",
        "middle_name": "D",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "13657",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.