Individual provider Active NPI

Nathanial Fernandez, MD

  • Vascular Surgery Physician
  • San Diego, CA
National Provider Identifier
1538212196
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
License
C165627 Issued in CA
Practice address
34730 Bob Wilson Dr
San Diego, CA 92134-3098
Phone
(619) 532-7177
NPI assigned
Jan 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X C165627 CA
Vascular Surgery Physician 2086S0129X C165627 CA Primary

Addresses

Primary practice location

34730 Bob Wilson Dr
San Diego, CA 92134-3098

Mailing address

34730 Bob Wilson Dr
San Diego, CA 92134-3098
Phone (619) 532-7177

Other practice location 1

9898 Genesee Ave
LA Jolla, CA 92037-1205
Phone (858) 824-5424

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
I20230228002791 CA Practitioner - Vascular Surgery 8820233968 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Vascular Surgery
Education
University of Colorado School of Medicine, Denver, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Scripps Health Inpatient Providers Medical Group IncGroup PAC ID 9436314762, 209 clinicians
Scripps HealthGroup PAC ID 9234033853, 1,450 clinicians

Practice addresses (Care Compare)

4077 5TH Ave
San Diego, CA 92103-2105
Phone (619) 294-8111

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

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Leg revascularization (restoring blood flow)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C165627CAMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trauma Team Medical Group Incorporated CurrentSince Jan 2, 2023 Accepting new patients
Scripps Health CurrentSince Apr 22, 2024 Accepting new patients
Scripps Health CurrentSince Apr 22, 2024 Accepting new patients
On Call Specialists Medical Group of San Diego, Inc. CurrentSince Sep 15, 2024 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Current Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients

Locations

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

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

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

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

4077 5th Ave
San Diego, CA 92103
Phone (619) 260-7245

650 E Devon Ave
Ste 165
Itasca, IL 60143
Phone (630) 285-1040

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.

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": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731542400000",
    "number": "1538212196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34730 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921343098",
            "telephone_number": "619-532-7177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34730 BOB WILSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921343098",
            "telephone_number": "619-532-7177"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9898 Genesee Ave",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920371205",
            "country_code": "US",
            "telephone_number": "858-824-5424",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FERNANDEZ",
        "first_name": "NATHANIAL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2024-11-14",
        "certification_date": "2024-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "C165627",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "C165627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.