NPIMap

Individual provider Active NPI

Theodore C Chan, MD

  • Emergency Medicine Physician
  • La Jolla, CA
National Provider Identifier
1477596856
Registry record updated May 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
G78148 Issued in CA
Practice address
9300 Campus Point Drive
La Jolla, CA 92037
Phone
(858) 657-7000
NPI assigned
Jun 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 8, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X G78148 CA Primary

Addresses

Primary practice location

9300 Campus Point Drive
La Jolla, CA 92037

Mailing address

File No 54826
Los Angeles, CA 90074-4826
Phone (888) 486-4340

Other identifiers 1

IdentifierTypeStateIssuer
00G781480MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100316000284 CA Practitioner - Emergency Medicine 3476688433 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of California, San Francisco School of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Regents of the University of CaliforniaGroup PAC ID 3577476761, shared by 18 NPIs, 2,047 clinicians

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-3109
Phone (858) 657-7000

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (858) 657-7000

Hospital & facility affiliations

  • UC San Diego Health Hillcrest - Hillcrest Med Ctr Hospital, San Diego, CA, CCN 050025

Merit-based Incentive Payment System (MIPS)

Final score
90.77 of 100Reported as group
Quality
84.13
Promoting interoperability
100
Improvement activities
40
Cost
73.88

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G78148CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Aug 29, 2016 Accepting new patients
UC San Diego Health Community Group CurrentSince Jan 3, 2019 Accepting new patients
Regents of the University of California CurrentSince Jul 1, 2022 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California Emergency Medicine CurrentSince Aug 29, 2016 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California Emergency Medicine CurrentSince May 1, 1996 Accepting new patients
Regents of the Unviersity of California Emergency Medicine Past Accepting new patients
Regents of the University of California Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

8910 Villa La Jolla Dr
Ste 100
La Jolla, CA 92037

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

File No 54826
Los Angeles, CA 90074

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

16950 Via Tazon
San Diego, CA 92127
Phone (858) 521-2265

Organizations & group practices 11

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 1

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": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210204800000",
    "number": "1477596856",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FILE NO 54826",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900744826",
            "telephone_number": "888-486-4340"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 CAMPUS POINT DRIVE",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "92037",
            "telephone_number": "858-657-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHAN",
        "first_name": "THEODORE",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "G78148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G781480",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.