Individual provider Active NPI

Peter J Witucki, MD

  • Emergency Medicine Physician
  • La Jolla, CA
National Provider Identifier
1548205537
Registry record updated May 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A75302 Issued in CA
Practice address
9300 Campus Point Dr
La Jolla, CA 92037
Phone
(858) 657-7000
NPI assigned
Jun 17, 2006
Last updated
May 23, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A75302 CA Primary
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician 207PE0005X A75302 CA

Addresses

Primary practice location

9300 Campus Point Dr
La Jolla, CA 92037

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Other identifiers 1

IdentifierTypeStateIssuer
00A753020MedicaidCA

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
I20040916001363 CA Practitioner - Emergency Medicine 0143298257 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Loyola University of Chicago, Stritch School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

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

Hospital & facility affiliations

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
A75302CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cep America - California Emergency Medicine CurrentSince Jul 15, 2004 Accepting new patients
Regents of the University of California Current Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Regents of the University of California CurrentSince Apr 15, 2023 Accepting new patients
Regents of the University of California Emergency Medicine CurrentSince Apr 15, 2023 Accepting new patients
Cep America-California Emergency Medicine CurrentSince Jul 15, 2004 Accepting new patients
Regents of the University of California Emergency Medicine CurrentSince Jul 1, 2003 Accepting new patients
Regents of the University of California Current Accepting new patients
Regents of the University of California Emergency Medicine CurrentSince Jul 1, 2003 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

207 W Legion Rd
Brawley, CA 92227
Phone (760) 351-3333

751 Medical Center Ct
#1182
Chula Vista, CA 91911

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

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

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 900-3125

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5720

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

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684800000000",
    "number": "1548205537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 232410",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921932410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9300 CAMPUS POINT DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "92037",
            "telephone_number": "858-657-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITUCKI",
        "first_name": "PETER",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2023-05-23",
        "certification_date": "2023-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A75302",
            "primary": true
        },
        {
            "code": "207PE0005X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "CA",
            "license": "A75302",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A753020",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.