Individual provider Active NPI

Carla Demeterco-Berggren, M.D.

  • Pediatrics Physician
  • San Diego, CA
National Provider Identifier
1619130655
Registry record updated Jul 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
A98629 Issued in CA
Practice address
8110 Birmingham Way
BLDG 28
San Diego, CA 92123-2758
Phone
(858) 966-4032
NPI assigned
Jul 9, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X A98629 CA Primary
Pediatric Endocrinology Physician 2080P0205X A98629 CA

Addresses

Primary practice location

8110 Birmingham Way
BLDG 28
San Diego, CA 92123-2758

Mailing address

3860 Calle Fortunada
Suite 210
San Diego, CA 92123-4800
Phone (858) 309-6303

Other names 1

  • Carla Demeterco 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
I20120420000526 CA Practitioner - Pediatric MedicinePractitioner - EndocrinologyPractitioner - Other (Physician) 0042471856 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
98629CAMDMarriage & Family Therapist
A98629CAMDPediatric Endocrinology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rady Children'S Hospital San Diego CurrentSince Feb 8, 2012 Accepting new patients
Rady Children'S Hospital San Diego Pediatrics CurrentSince Feb 8, 2012 Accepting new patients
Marilyn Kaufhold, M.D., a Medical Corporation Past Accepting new patients

Locations

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

25170 Hancock Ave
Fl 1
Murrieta, CA 92562

3030 Childrens Way
Fl 4
San Diego, CA 92123
Phone (858) 966-5846

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

8110 Birmingham Way
Bldg 28
San Diego, CA 92123
Phone (858) 966-4003

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

Interoperability endpoints

  • Direct secure messaging: cdemeterco9724@radychildrens.direct-ci.com

Organizations & group practices 3

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": "1215561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1215561600000",
    "number": "1619130655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 CALLE FORTUNADA",
            "address_2": "SUITE 210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234800",
            "telephone_number": "858-309-6303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8110 BIRMINGHAM WAY",
            "address_2": "BLDG 28",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232758",
            "telephone_number": "858-966-4032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEMETERCO-BERGGREN",
        "first_name": "CARLA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-09",
        "last_updated": "2008-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "A98629",
            "primary": true
        },
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "CA",
            "license": "A98629",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLA",
            "last_name": "DEMETERCO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.