Individual provider Active NPI

Manish Champaneria, MD

  • Plastic and Reconstructive Surgery Physician
  • San Diego, CA
National Provider Identifier
1437356375
Registry record updated Dec 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
MD60337579 Issued in WA
Practice address
12395 El Camino Real Ste 112
San Diego, CA 92130
Phone
(858) 554-9930
NPI assigned
Jul 2, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X MD60337579 WA Primary
Plastic and Reconstructive Surgery Physician 2086S0122X A105454 CA
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

12395 El Camino Real Ste 112
San Diego, CA 92130

Mailing address

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (858) 554-9930

Other identifiers 1

IdentifierTypeStateIssuer
1437356375MedicaidWA

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
I20190107000090 CA Practitioner - Plastic and Reconstructive Surgery 4587802236 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
University of Minnesota Medical School, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

10666 N Torrey Pines Rd
La Jolla, CA 92037-1027
Phone (858) 554-9100

354 Santa Fe Dr
Encinitas, CA 92024-5142
Phone (760) 633-6501

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy56
Melanoma (skin cancer) excision45

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A105454CAMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health CurrentSince Dec 10, 2018 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Dec 10, 2018 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Current Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients
Scripps Health Past Accepting new patients
Scripps Health Past Accepting new patients
Scripps Health 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

12395 El Camino Real
Ste 112
San Diego, CA 92130
Phone (619) 670-5400

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

15004 Innovation Dr
San Diego, CA 92128
Phone (858) 487-1800

Interoperability endpoints

  • Direct secure messaging: mchampaneria177341@scrippshlth.medalliesdirect.net
  • Direct secure messaging: mchampaneria62918@direct.peacehealth.org

Organizations & group practices 9

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": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545868800000",
    "number": "1437356375",
    "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": "858-554-9930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12395 EL CAMINO REAL STE 112",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92130",
            "telephone_number": "858-554-9930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAMPANERIA",
        "first_name": "MANISH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2018-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "WA",
            "license": "MD60337579",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A105454",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1437356375",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.