Individual provider Active NPI

Jill C. Buckley, M.D.

  • Urology Physician
  • San Diego, CA
National Provider Identifier
1730198128
Registry record updated Apr 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A77631 Issued in CA
Practice address
200 W Arbor Dr
San Diego, CA 92103-9000
Phone
(858) 657-8860
Fax
(858) 228-1740
NPI assigned
Aug 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X A77631 CA Primary

Addresses

Primary practice location

200 W Arbor Dr
San Diego, CA 92103-9000

Mailing address

PO Box 232410
San Diego, CA 92193-2410

Other identifiers 1

IdentifierTypeStateIssuer
110077554AMedicaidMA

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
I20130830000467 CA Practitioner - Urology 8628076445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of California, Geffen School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

200 W Arbor Dr
San Diego, CA 92103-1920
Phone (858) 249-6753

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Melanoma (skin cancer) excision1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A77631CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of California CurrentSince Jul 1, 2013 Accepting new patients
Regents of the University of California Urology CurrentSince Jul 1, 2013 Accepting new patients
Lahey Clinic, Inc. Past Accepting new patients
Regents of the University of California Past Accepting new patients
Lahey Clinic, Inc Past Accepting new patients
Rady Children's Hospital San Diego Past Accepting new patients
Regents of the University of California Ucsd Head and Neck Surgery Past Accepting new patients

Locations

9400 Campus Point Dr
La Jolla, CA 92093
Phone (858) 249-3800

4520 Executive Dr
Ste 111
San Diego, CA 92121
Phone (858) 657-7237

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

Organizations & group practices 7

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 1

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524787200000",
    "number": "1730198128",
    "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": "200 W ARBOR DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921039000",
            "telephone_number": "858-657-8860",
            "fax_number": "858-228-1740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "JILL",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2018-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A77631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110077554A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.