Individual provider Active NPI

Lalita Khaodhiar Tantisira, M.D.

  • Endocrinology, Diabetes & Metabolism Physician
  • San Diego, CA
National Provider Identifier
1508874298
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
C170095 Issued in CA
Practice address
12395 El Camino Real
San Diego, CA 92130-3082
Phone
(858) 793-2727
NPI assigned
Aug 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X C170095 CA Primary

Addresses

Primary practice location

12395 El Camino Real
San Diego, CA 92130-3082

Mailing address

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (858) 793-2727

Other practice location 1

200 W Arbor Dr
San Diego, CA 92103-9000
Phone (800) 926-8273

Other names 1

  • Lalita Khaodhiar 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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201214001036 CA Practitioner - Endocrinology 6709881592 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 1991
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)

12395 El Camino Real
Suite 112
San Diego, CA 92130-3084
Phone (858) 554-9100

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

Merit-based Incentive Payment System (MIPS)

Final score
92.21 of 100Reported as apm
Quality
90.43
Promoting interoperability
90
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C170095CAMDEndocrinology, Diabetes & Metabolism Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Current Accepting new patients
Regents of the University of California Endocrinology, Diabetes & Metabolism CurrentSince Nov 8, 2020 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health CurrentSince Dec 9, 2024 Accepting new patients
Regents of the University of California CurrentSince Nov 8, 2020 Accepting new patients
Scripps Health CurrentSince Dec 9, 2024 Accepting new patients
Regents of the University of California Current Accepting new patients
Scripps Clinic Medical Group 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 317
San Diego, CA 92130
Phone (619) 793-0055

12395 El Camino Real
Ste 120
San Diego, CA 92130
Phone (858) 793-2727

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

12395 El Camino Real
San Diego, CA 92130
Phone (858) 793-2727

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

Organizations & group practices 8

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": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1508874298",
    "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": "858-793-2727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12395 EL CAMINO REAL",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921303082",
            "telephone_number": "858-793-2727"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W Arbor Dr",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921039000",
            "country_code": "US",
            "telephone_number": "800-926-8273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANTISIRA",
        "first_name": "LALITA",
        "middle_name": "KHAODHIAR",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "C170095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LALITA",
            "last_name": "KHAODHIAR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.