Individual provider Active NPI

Jose Alfonso Silva Sepulveda, M.D.

  • Pediatric Cardiology Physician
  • San Diego, CA
National Provider Identifier
1417222472
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
License
A120119 Issued in CA
Practice address
3020 Childrens Way
San Diego, CA 92123-4223
Phone
(858) 966-5855
NPI assigned
Mar 9, 2012
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A120119 CA
Pediatrics Physician 208000000X A120119 CA
Pediatric Cardiology Physician 2080P0202X A120119 CA Primary

Addresses

Primary practice location

3020 Childrens Way
San Diego, CA 92123-4223

Mailing address

3020 Childrens Way # Mc5003
San Diego, CA 92123-4223
Phone (858) 309-6300

Other practice location 1

2020 Zonal Ave Ste Room115
Los Angeles, CA 90089-0121
Phone (323) 226-5610

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
I20171027001276 CA Practitioner - Other (Physician)Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal MedicinePractitioner - Pediatric Medicine 8527334085 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Undefined Physician Type (Specify)Also: Internal Medicine, Pediatric Medicine
Education
University of Southern California Keck School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3010 Childrens Way
San Diego, CA 92123-4223
Phone (858) 576-1700

3020 Children's Way
San Diego, CA 92123-4223
Phone (858) 576-1700

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A120119CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
County of Los Angeles CurrentSince Aug 12, 2021 Accepting new patients
County of Los Angeles CurrentSince Aug 12, 2021 Accepting new patients
County of Los Angeles Current Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation PastSince Jul 24, 2022 Accepting new patients
County of Los Angeles Past Accepting new patients

Locations

1000 S Fremont Ave
Unit 9
Alhambra, CA 91803

2829 S Grand Ave
Los Angeles, CA 90007
Phone (213) 699-7000

5850 S Main St
Los Angeles, CA 90003
Phone (323) 846-4312

Interoperability endpoints

  • Direct secure messaging: jsepulveda152349@radychildrens.direct-ci.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1417222472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-5855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2020 Zonal Ave Ste Room115",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900890121",
            "country_code": "US",
            "telephone_number": "323-226-5610",
            "fax_number": "323-226-3853",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SILVA SEPULVEDA",
        "first_name": "JOSE",
        "middle_name": "ALFONSO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-03-09",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A120119",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A120119",
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "CA",
            "license": "A120119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.