Individual provider Active NPI

Alexander Nicholas Prevallet, DO

  • Hospitalist Physician
  • San Diego, CA
National Provider Identifier
1659833556
Registry record updated Sep 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
20A19716 Issued in CA
Practice address
4077 Fifth Ave # Mer35
San Diego, CA 92103-2105
Phone
(619) 688-0770
NPI assigned
Apr 1, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 20A19716 CA Primary
Internal Medicine Physician 207R00000X 20A19716 CA

Addresses

Primary practice location

4077 Fifth Ave # Mer35
San Diego, CA 92103-2105

Mailing address

4077 Fifth Ave
San Diego, CA 92103-2105
Phone (619) 686-3935

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
I20220802000833 CA Practitioner - HospitalistPractitioner - Internal MedicinePractitioner - Geriatric Medicine 0244612638 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
19716CAMDEndodontist
20A19716CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Scripps Health Inpatient Providers Medical Group Inc. Hospitalist CurrentSince Jul 18, 2022 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Aug 24, 2022 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Aug 24, 2022 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Internal Medicine CurrentSince Aug 15, 2022 Accepting new patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Scripps Health CurrentSince Aug 15, 2022 Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Current Accepting new patients
Scripps Health Internal Medicine Current Accepting new patients
Scripps Health Past Accepting new patients

Locations

435 H St
Chula Vista, CA 91910
Phone (619) 691-7000

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

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

4094 4th Ave
San Diego, CA 92103
Phone (619) 515-2545

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

10010 Campus Point Dr
#305
San Diego, CA 92121
Phone (619) 452-7071

4077 5th Ave
#35
San Diego, CA 92103
Phone (619) 260-7220

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

550 Washington St
San Diego, CA 92103
Phone (619) 297-5437

Interoperability endpoints

  • Direct secure messaging: aprevallet285614@scrippshlth.medalliesdirect.net

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1554076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1659833556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "619-686-3935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4077 FIFTH AVE # MER35",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921032105",
            "telephone_number": "619-688-0770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREVALLET",
        "first_name": "ALEXANDER",
        "middle_name": "NICHOLAS",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-01",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "20A19716",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A19716",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.