NPIMap

Organization Active NPI

La Jolla Observation Medicine

  • Emergency Medicine Physician
  • La Jolla, CA
National Provider Identifier
1780122986
Registry record updated Jan 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 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
Last updated
Jan 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2025

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

Authorized official

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

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207P00000X Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

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

National Provider Directory

Locations

9888 Genesee Ave
Ste LJ105
La Jolla, CA 92037

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 40

NPI Registry JSON

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

{
    "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

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.