Individual provider Active NPI

Brian Hilton Graham, M.D,

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • La Jolla, CA
National Provider Identifier
1376665794
Registry record updated Jun 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
License
G67969 Issued in CA
Practice address
6455 La Jolla Blvd Unit 315
La Jolla, CA 92037-6638
Phone
(619) 665-2159
Fax
(858) 836-1159
NPI assigned
Apr 5, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 24, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X G67969 CA Primary

Addresses

Primary practice location

6455 La Jolla Blvd Unit 315
La Jolla, CA 92037-6638

Mailing address

6455 La Jolla Blvd, 315
La Jolla, CA 92037-6638
Phone (619) 665-2159

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
I20150720001352 CA Practitioner - General Practice 2567775604 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G67969CAMDHospice and Palliative Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
NR Medical Associates CurrentSince Dec 5, 2017 Accepting new patients
Mobile Medical Group Past Accepting new patients

Locations

555 Washington St
San Diego, CA 92103
Phone (619) 260-8300

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
HospicemdSan Diego, CA, CCN A11568 Hospice Contracted Managing Employee Jan 1, 2021

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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": "1175731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277337600000",
    "number": "1376665794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6455 LA JOLLA BLVD, 315",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920376638",
            "telephone_number": "619-665-2159",
            "fax_number": "858-836-1159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6455 LA JOLLA BLVD UNIT 315",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920376638",
            "telephone_number": "619-665-2159",
            "fax_number": "858-836-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "BRIAN",
        "middle_name": "HILTON",
        "credential": "M.D,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-05",
        "last_updated": "2010-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "CA",
            "license": "G67969",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.