Individual provider Active NPI

Courtney Thornburg, M.D.

  • Pediatric Hematology & Oncology Physician
  • San Diego, CA
National Provider Identifier
1538222310
Registry record updated Nov 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Hematology & Oncology PhysicianTaxonomy code 2080P0207X
License
C 55985 Issued in CA
Practice address
3010 Childrens Way
San Diego, CA 92123-4223
Phone
(858) 966-5811
Fax
(858) 966-8035
NPI assigned
Dec 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2014

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2005-00360 NC
Pediatric Hematology & Oncology Physician 2080P0207X 2005-00360 NC
Pediatrics Physician 208000000X C 55985 CA
Pediatric Hematology & Oncology Physician 2080P0207X C 55985 CA Primary

Addresses

Primary practice location

3010 Childrens Way
San Diego, CA 92123-4223

Mailing address

3020 Childrens Way
MC 5003
San Diego, CA 92123-4223
Phone (858) 309-6300

Other identifiers 1

IdentifierTypeStateIssuer
5900803MedicaidNC

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
I20131118000032 CA Practitioner - Pediatric MedicinePractitioner - Hematology/Oncology 1153397187 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005-00360NCMDPediatrics Physician
C 55985CAMDPediatric Hematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rady Children'S Hospital San Diego Pediatrics CurrentSince Jul 15, 2013 Accepting new patients
Rady Children'S Hospital San Diego CurrentSince Jul 15, 2013 Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation Past Accepting new patients
Pediatric Subspecialty Faculty, Inc. Pediatrics Past Accepting new patients

Locations

25170 Hancock Ave
Murrieta, CA 92562
Phone (858) 757-3277

1201 W La Veta Ave
Orange, CA 92868
Phone (714) 509-8481

3020 Childrens Way
#5003
San Diego, CA 92123
Phone (858) 309-6300

3010 Childrens Way
San Diego, CA 92123
Phone (858) 966-5811

3020 Childrens Way
San Diego, CA 92123
Phone (858) 966-5841

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415750400000",
    "number": "1538222310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "address_2": "MC 5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300",
            "fax_number": "858-309-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-5811",
            "fax_number": "858-966-8035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THORNBURG",
        "first_name": "COURTNEY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2014-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2005-00360",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "NC",
            "license": "2005-00360",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "C 55985",
            "primary": false
        },
        {
            "code": "2080P0207X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Hematology-Oncology",
            "state": "CA",
            "license": "C 55985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5900803",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.