NPIMap

La Jolla Observation Medicine

Organization Active NPI Emergency Medicine Physician · La Jolla, CA

NPI 1780122986 · NPPES record last updated Jan 3, 2025

Key facts

NPI
1780122986
Entity type
Organization (NPI type 2)
Primary specialty
Emergency Medicine Physician 207P00000X
Legal business name
LA JOLLA OBSERVATION MEDICINE
Practice address
9888 Genesee Ave
La Jolla, CA 92037-1205
Phone
(858) 626-6150
Fax
(626) 623-1227
NPI assigned
Feb 7, 2017
Organization subpart
No

Authorized official

Name
Taylor Y. Cardall, MD NPI 1770534067
Title
Billing Liason
Phone
(858) 626-6902

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

Medicare participation

Medicare fee-for-service enrollment
Enrolled in CA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20170331001702 CA Part B Supplier - Clinic/Group Practice 2365727492 Receives reassigned benefits from 38 practitioners
Practice locations: La Jolla, CA

National Provider Directory

Locations

9888 Genesee Ave
Ste LJ105
La Jolla, CA 92037

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207P00000X Yes

Addresses

Primary practice location

9888 Genesee Ave
La Jolla, CA 92037-1205

Mailing address

9888 Genesee Ave Ste LJ-105
La Jolla, CA 92037-1205
Phone (858) 824-6742

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 3, 2025.

{
    "created_epoch": "1486425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1735862400000",
    "number": "1780122986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE STE LJ-105",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "858-824-6742",
            "fax_number": "858-824-7989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9888 GENESEE AVE",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920371205",
            "telephone_number": "858-626-6150",
            "fax_number": "626-623-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA JOLLA OBSERVATION MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-07",
        "last_updated": "2025-01-03",
        "certification_date": "2025-01-03",
        "status": "A",
        "authorized_official_last_name": "CARDALL",
        "authorized_official_first_name": "TAYLOR",
        "authorized_official_middle_name": "Y.",
        "authorized_official_title_or_position": "BILLING LIASON",
        "authorized_official_telephone_number": "858-626-6902",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Jolla, CA

All providers in La Jolla, CA · Emergency Medicine Physician in California

Sources for this page

Verify at the official NPI Registry.