Nicholas Ryan Whitley, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A118250 Issued in CA

Practice address

4004 Beyer Blvd
San Ysidro, CA 92173-2007

Phone

(619) 662-4100

Fax

(619) 428-7952

NPI assigned

Apr 14, 2010

Last updated

Jun 27, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

Family Practice

Education

University of Southern California Keck School of Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Centro de Salud de la Comunidad de San Ysidro,Inc.Group PAC ID 6901709435, 291 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: nwhitley18310@syhealth.direct-ci.com

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.

• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health Precision Park

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1124782685
  Medicare reassignment Care Compare group NPD
• Centro de Salud de la Comunidad de San Ysidro Inc

  dba San Ysidro Health Senior Dental Center

  • Federally Qualified Health Center (FQHC)
  • San Diego, CA
  • NPI 1457033813
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba General Physician Group Multi Specialty

  • Federally Qualified Health Center (FQHC)
  • San Ysidro, CA
  • NPI 1164641965
  NPD
• Centro de Salud de la Comunidad de San Ysidro, Inc.

  dba San Ysidro Health National City

  • Federally Qualified Health Center (FQHC)
  • National City, CA
  • NPI 1003869363
  NPD (past)
• Grossmont Hospital Corporation

  dba Sharp Grossmont Hospital

  • General Acute Care Hospital
  • La Mesa, CA
  • NPI 1528041811
  NPD (past)
• Scripps Health

  dba Scripps Mercy Hospital

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1659359446
  NPD (past)
• Sharp Chula Vista Medical Center

  dba Birch Patrick Convalescent Center

  • Skilled Nursing Facility
  • Chula Vista, CA
  • NPI 1538142369
  NPD (past)
• Sharp Memorial Hospital

  dba Sharp Allison deRose Rehabilitation Center

  • Rehabilitation Hospital Unit
  • San Diego, CA
  • NPI 1114901352
  NPD (past)
• Sharp Memorial Hospital

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1407839921
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1271203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1629394721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732007",
            "telephone_number": "619-662-4100",
            "fax_number": "619-428-7952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4004 BEYER BLVD",
            "city": "SAN YSIDRO",
            "state": "CA",
            "postal_code": "921732007",
            "telephone_number": "619-662-4100",
            "fax_number": "619-428-7952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITLEY",
        "first_name": "NICHOLAS",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-14",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A118250",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karina Victorino, LCSW
• Vida Hospice Services Southern Inc
• Denise Villezcas, MS
• Laura Viramontes
• Charles Elmer Walker, LMFT
• Tom Ellis Williams, MD
• Diana Wong
• Wayne Bon Wong
• Stephanie Wooden, MSW
• Xpquick Claims Inc

• Family Medicine Physician in San Ysidro, CA
• Providers in San Ysidro, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.