Individual provider Active NPI

Madelyn Couderc

  • Physician Assistant
  • La Jolla, CA
National Provider Identifier
1548947245
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA63243 Issued in CA
Practice address
10710 N Torrey Pines Rd
La Jolla, CA 92037-1035
Phone
(858) 554-9100
NPI assigned
Jul 3, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA63243 CA Primary

Addresses

Primary practice location

10710 N Torrey Pines Rd
La Jolla, CA 92037-1035

Mailing address

10790 Rancho Bernardo Rd
San Diego, CA 92127-5705
Phone (858) 554-9999

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231009003275 CA Practitioner - Physician Assistant 7618322777 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
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)

10666 N Torrey Pines Rd
La Jolla, CA 92037-1027
Phone (858) 554-9100

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

9896 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 626-4123

9898 Genesee Ave
La Jolla, CA 92037-1205
Phone (858) 455-9100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
63243CAMDPharmacist
PA63243CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health CurrentSince Oct 2, 2023 Accepting new patients
Scripps Health CurrentSince Oct 2, 2023 Accepting new patients
Scripps Health Physician Assistant Current Accepting new patients
Scripps Health Past Accepting new patients
Scripps Clinic Medical Group Past Accepting new patients

Locations

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

10710 N Torrey Pines Rd
La Jolla, CA 92037
Phone (858) 554-7993

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

10790 Rancho Bernardo Rd
San Diego, CA 92127
Phone (858) 554-2626

Organizations & group practices 5

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 4

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": "1688342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694649600000",
    "number": "1548947245",
    "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": "858-554-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10710 N TORREY PINES RD",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371035",
            "telephone_number": "858-554-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUDERC",
        "first_name": "MADELYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-03",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA63243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

Sources for this page

Verify at the official NPI Registry.