Individual provider Active NPI

Gwen S Janczyk, PA

  • Physician Assistant
  • La Jolla, CA
National Provider Identifier
1417022013
Registry record updated Jan 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA15930 Issued in CA
Practice address
9898 Genesee Ave
La Jolla, CA 92037-1205
Phone
(858) 824-5353
NPI assigned
Nov 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA15930 CA
Physician Assistant 363A00000X PA15930 CA Primary

Addresses

Primary practice location

9898 Genesee Ave
La Jolla, CA 92037-1205

Mailing address

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (858) 824-5353

Other names 1

  • Gwen S Whitehead Former name

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
I20090316000516 CA Practitioner - Physician Assistant 3072670231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
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)

326 Santa Fe Dr
Encinitas, CA 92024-5156

3811 Valley Centre Dr
San Diego, CA 92130-3318
Phone (858) 764-3000

9888 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9896 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9898 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 455-9100

Hospital & facility affiliations

  • Scripps Memorial Hospital la Jolla Hospital, La Jolla, CA, CCN 050324
  • Scripps Mercy Hospital Hospital, San Diego, CA, CCN 050077

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15930CAMDMental Health Counselor
PA15930CAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health CurrentSince Oct 27, 2013 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Oct 27, 2013 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Past Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients

Locations

9898 Genesee Ave
La Jolla, CA 92037
Phone (858) 824-5222

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

10666 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-2626

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

25405 Hancock Ave
Ste 216
Murrieta, CA 92562
Phone (858) 554-8730

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

3811 Valley Centre Dr
San Diego, CA 92130
Phone (858) 554-8645

9730 Summers Ridge Rd
#100
San Diego, CA 92121
Phone (858) 549-7400

Interoperability endpoints

  • Direct secure messaging: gjanczyk11880@scrippshlth.medalliesdirect.net

Organizations & group practices 6

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 2

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": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580256000000",
    "number": "1417022013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10790 RANCHO BERNARDO RD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921275705",
            "telephone_number": "858-824-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9898 GENESEE AVE",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "858-824-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JANCZYK",
        "first_name": "GWEN",
        "middle_name": "S",
        "name_prefix": "Mrs.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-21",
        "last_updated": "2020-01-29",
        "certification_date": "2020-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA15930",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA15930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GWEN",
            "last_name": "WHITEHEAD",
            "middle_name": "S",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.